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Pharmacology I Exam #2 > KNOW THIS SHIT > Flashcards

KNOW THIS SHIT Flashcards

1
Q

What is the MOA for all Beta-Lactam antibiotics? What three things are absolutely necessary for these antibiotics to work?

A

Bind to PBP → interferes with cell wall integrity → cell lysis
- Must have ACTIVE GROWTH, PBPS and AUTOLYSINS

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2
Q

What makes G- different from G+?

A

Both contain a layer of peptidoglycan but G- also has an extra outer membrane

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3
Q

What is transpeptidation of peptidoglycan?

A

Forms links between amino acid side chains on NAM molecules

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4
Q

What is the main MOR for Penicillin?

A

Penicillinase binds to beta-lactam ring on the antibiotic and hydrolyzes it, inactivating the antibiotic

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5
Q

What is the primary toxicity for PCNs?

A

Hypersensitivity

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6
Q

What is the advantage of using Penicillinase-Resistance PCN over the other three PCNs (besides that it works against Penicillinase…)?

A

Hepatic metabolism so can be used if there is poor kidney function

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7
Q

Which group of antibiotics is the most effective against G+?

A

PCNs specifically Natural Penicillins

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8
Q

What is the DOC for MSSA? What are the three medications in this group?

A

Penicillinase-Resistance PCNs

  • Nafcillin
  • Dicloxacillin
  • Oxacillin
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9
Q

What group of antibiotics cannot be used to treat MRSA? What is the one medication exception to this?

A

NO BETA-LACTAMS can treat MRSA

- Exception: Ceftaroline

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10
Q

What is the DOC for Lysteria infections? What are the two medications in this group?

A

Extended-Spectrum PCNs

  • Ampicillin
  • Amoxicillin
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11
Q

What is the spectrum of Antipseudomonal PCNs?

A

Extended-Spectrum PCNs plus some G- (including Pseudomonas)

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12
Q

What is the primary DOC/use for Antipseudomonal PCNs? What are the two medications in this group?

A

Pseudomonas aeruginosa

  • Piperacillin
  • Ticarcillin
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13
Q

Beta-lactamase inhibitors can be added to which two groups of PCNs (and which four medications specifically)? What does this allow for?

A

Extended-Spectrum PCNs

  • Ampicillin
  • Amoxicillin

Antipseudomonal PCNs

  • Piperacillin
  • Ticarcillin

Provides further extended spectrum

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14
Q

What group of antibiotics is always combined with Antipseudomonal PCNs?

A

Aminoglycosides

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15
Q

What group of antibiotics is the DOC for Streptococcus pneumoniae?

A

PCNs

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16
Q

What two groups of antibiotics or medications are the DOC for Group A Streptococcus?

A
  • PCNs

- Clindamycin

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17
Q

What group of anitbiotics is DOC for S. aureus?

A

PCNs

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18
Q

What is the DOC for Listeria infections?

A

Ampicillin

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19
Q

What is the DOC for early Lyme disease (besides Doxycycline)?

A

Amoxicillin

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20
Q

What is the advantage of using a Cephalosporin over a PCN?

A

7-methyl group of Cephalosporins increases their resistance to B-lactamases

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21
Q

Which two Cephalosporin generations are very similar to each other in terms of spectrum? What is their spectrum?

A

1 and 2 both have good G+ activity with some G-

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22
Q

What is the DOC for surgical prophylaxis?

A

Cefazolin

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23
Q

Which three G- organisms are the 1st and 2nd generation Cephalosporins a DOC for?

A
  • E. coli
  • Klebsiella
  • Proteus
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24
Q

What are the two possible DOC for Neisseria gonorrheae?

A
  • Ceftriaxone

- Cefpodoxime

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25
Q

Which two 3rd generation Cephalosporins have good CNS penetration?

A
  • Ceftriaxone

- Cefotaxime

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26
Q

Which two Cephalosporins are considered alternatives to PCN when treating Pseudomonas?

A

Aminoglycosides +

  • Ceftazadime
  • Cefepime
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27
Q

Which Cephalosporins has the broadest coverage? Why is this important in terms of use?

A

Cefepime (Maxipime)

- Can be used empirically

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28
Q

What is the DOC for late stage Lyme disease?

A

Ceftriaxone

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29
Q

What two diseases is Ceftaroline effective against that many medications are not?

A
  • MRSA

- VRSA

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30
Q

Which two groups of antibiotics or medications can exhibit a disulfarim-like reaction? What should be avoided?

A

Avoid EtOH use with…

  • Cephalosporins
  • Metronidazole
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31
Q

Which group of antibiotics exhibits synergistic nephrotoxicity when combined with Aminoglycosides?

A

Cephalosporins

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32
Q

What type of toxicity are you concerned about with PCN and Cephalosporins?

A

Cross-sensitivity

- If allergic to PCN, 10% chance you are also allergic to Cephalosporins

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33
Q

Which group of antibiotics/medication is considered a good alternative to PCN (if allergy) due to no cross-sensitivity with other beta-lactams?

A

Monobactams (Aztreonam)

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34
Q

What inhibitor must be given with Imipenem? Why?

A

Cilastin must be given with Imipenem because without it, Imipenem is rapidly inactivated by renal tubule dihydropepdidases

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35
Q

What is the DOC for Beta-Lactamase producing Enterobacter infections?

A

Imipenem

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36
Q

What is the primary side effect of Imipenem? What is a very similar, but less risky alternative?

A

Seizures

- Use Meropenem instead

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37
Q

What is the DOC for MRSA?

A

Vancomycin (IV)

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38
Q

What is the DOC for C. difficile?

A

Vancomycin (oral)

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39
Q

What is the MOA for Vancomycin?

A

Binds to terminal D-ala (different from PBP)

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40
Q

What are the three primary toxicities associated with Vancomycin?

A
  • Ototoxicity
  • Nephrotoxicity
  • Red man syndrome
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41
Q

What is the MOA for Fosfomycin?

A

Prevents NAG to NAM reduction

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42
Q

What is the primary use for Fosfomycin? Why is it not considered the DOC for this use?

A

UTI in women
- Bactrim then Cipro are DOC for UTIs because Fosfomycin also acts on other parts of the body, not just the urinary tract

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43
Q

What is the MOA for Bacitracin?

A

Inhibits transport across cell membrane

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44
Q

What are the two antibiotic groups that act on the 30s ribosomal subunit during inhibition of protein synthesis (exceptions to the 50s rule)?

A
  • Aminoglycosides

- Tetracyclines

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45
Q

What is the one antibiotic group that is bactericidal during inhibition of protein synthesis (exception to static rule)?

A

Aminoglycosides

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46
Q

Of the three Macrolides, which is the most toxic?

A

Erythromycin

47
Q

What is the DOC for Neisseria meningitidis?

A

Penicillin G

48
Q

What two antibiotic groups or medications are DOC for E. coli, Klebsiella and Proteus?

A
  • 1st, 2nd gen Cephalosporins

- Bactrim

49
Q

Of the three Macrolides, which is most toxic for prolonged QT? Which are best?

A

Azithromycin

- Erythromycin = Clarithromycin are best

50
Q

Of the three Macrolides, which is most toxic for diarrhea? Which is best?

A

Erythromycin

- Clarithromycin is best

51
Q

Of the three Macrolides, which two are most toxic for drug interactions?

A
  • Erythromycin

- Clarithromycin

52
Q

What is the primary toxicity associated with Telithromycin?

A

Hepatotoxicity

53
Q

What is the DOC for osteomyelitis?

A

Clindamycin

54
Q

What is the DOC for Toxic Shock Syndrome? What three medications should it be combined with?

A

Clindamycin

- Use with Vancomycin, Nafcillin or 1st gen Cephalosporin

55
Q

When should you STOP use of Clindamycin? What medication should then be started?

A

CDAD or C. diff overgrowth occurs

- Begin oral Vancomycin

56
Q

What is the only condition that Telithromycin is still used to treat? What is the preferred option over Telithromycin?

A

CAP

- Levofloxacin or PCN preferred

57
Q

Is Clindamycin primarily bacteriostatic or bactericidal? Can this change?

A

Primarily bacteriostatic

- Can be bactericidal depending on concentration or susceptibility

58
Q

What two medications are typically bacteriostatic independently, unless combined to be used synergistically (becoming bactericidal)?

A

Dalfopristin + Quinupristin

- Static but when combined, become bactericidal

59
Q

What MOA group of antibiotics becomes bactericidal when combined together?

A

IPS

- Two IPS = cidal

60
Q

What is the primary concern when using Linezolid?

A

It is an inhibitor of MOA

61
Q

Patients with either of these two things should avoid use of Linezolid…

A
  • Pheochromocytoma
  • Drugs that increase MOAs (antidepressants)

Linezolid is an MOA inhibitor so if present, MOAs will not be eliminated properly and will instead accumulate

62
Q

What is important to know about the group of Aminoglycosides (different from all other antibiotics we learned about…)

A

IT IS BIG IN 2 WAYS…

  • Large size and polar: requires oxygen/active transport
  • Many different uses
63
Q

Knowing that Aminoglycosides are large in size, what does this tell you about their spectrum?

A

Requires oxygen/active transport because so large/polar so…
- ONLY WORKS AGAINST AEROBES (also G-)

64
Q

What are the two primary toxicities associated with Aminoglycosides? How can this toxicity be affected?

A
  • Ototoxicity
  • Nephrotoxicity

Toxicity is dependent on time and concentration of drug

65
Q

What is the only antibiotic group that irreversibly inhibits protein synthesis? What does this say about the group?

A

Aminoglycosides irreversibly inhibit protein synthesis

- Bactericidal!!!

66
Q

What is the DOC for Tularemia, Bubonic plague and TB?

A

Aminoglycosides

67
Q

Why must PCN be combined with Aminoglycosides to be effective against Pseudomonas or Enterococci?

A

PCN opens cell wall and Aminoglycosides lyses cell

68
Q

What group of antibiotics exhibits resistance within its own group?

A

Aminoglycosides

69
Q

Chloramphenicol is broad spectrum with 100% CNS penetration, so why isn’t it used more?

A

VERY toxic…

70
Q

What concentration dependent adverse effect is Chloramphenicol associated with? Why is this concentration dependent?

A

Bone marrow suppression

- Effects stop when medication dose is altered/stopped

71
Q

What non-concentration dependent adverse effect is Chloramphenicol associated with?

A

Fatal aplastic anemia

72
Q

What antibiotic is associated with grey baby syndrome?

A

Chloramphenicol

73
Q

What antibiotic has 100% CNS penetration?

A

Chloramphenicol

74
Q

What three groups of antibiotics or medications are associated with toxicity/contraindicated in children?

A
  • Ceftriaxone
  • Sulfa drugs
  • Chloramphenicol
75
Q

What is the concern for using Ceftriaxone on neonates/children?

A

Bilirubin displacement

76
Q

What is the concern for using Sulfa drugs on neonates/children?

A

Kernicterus (bilirubin displacement)

77
Q

What is the concern for using Chloramphenicol on neonates/children?

A

Grey baby syndrome

78
Q

What are the two DOC for H. pylori? What one drug must be combined with either of these?

A

Tetracyclines or Azithromycin

- Combined with Metronidazole

79
Q

What two groups of antibiotics are the DOC for Chlamydia?

A
  • Tetracyclines

- Macrolides (Azithromycin, Erythromycin)

80
Q

What two groups of antibiotics or medications are the DOC for Mycoplasma pneumoniae?

A
  • Tetracyclines

- Erythromycin

81
Q

What is the primary MOR for Tetracyclines? What is important to note about this in terms of cross resistance?

A

Efflux pumps

- There is NO cross-resistance across class (if resistant to one, can still try the other two)

82
Q

What is the primary toxicity associated with Tetracyclines? What other group of antibiotics also exhibit this toxicity?

A

Chelation with supplements (calcium, iron): causes decreased absorption
- Also Fluoroquinolones

83
Q

What are three important adverse effects associated with Tetracyclines?

A
  • Bone discoloration
  • Tooth discoloration
  • Photosensitivity
84
Q

What is the MOA for Fluoroquinolones?

A

Target DNA gyrase or topoisomerase (DNA cannot uncoil to replicate)

85
Q

What are the two DOC for UTIs?

A
  • Bactrim

- Ciprofloxacin

86
Q

What is the DOC for P. aeruginosa?

A

Antiseudomonal PCN + aminoglycoside

87
Q

What is the DOC for prostatitis?

A

Ofloxacin

88
Q

What is the DOC for community-acquired pneumonia (CAP)?

A

Levofloxacin

89
Q

Which two medications from the Fluoroquinolones group are effective against anaerobes?

A
  • Moxifloxacin

- Gemifloxacin

90
Q

Which medication from the Fluoroquinolones group is only ocular application?

A

Gatifloxacin

91
Q

What is the unique adverse effect associated with Fluoroquinolones?

A

Achilles tendon rupture

92
Q

What are the four most significant toxicities associated with Fluoroquinolones?

A
  • Tendon rupture
  • Prolonged QT interval
  • Photosensitivity
  • Cartilage erosion
93
Q

What is the primary contraindication associated with Fluoroquinolones?

A

Children less than 18 years due to cartilage erosion

94
Q

What is the spectrum of Metronidazole?

A

ONLY anaerobes

95
Q

What is the 2nd DOC for C. diff after oral Vancomycin?

A

Metronidazole

96
Q

Which antibiotic is associated with a metallic taste when taken orally?

A

Metronidazole

97
Q

What three conditions must be met in order for a medication to be considered effective against UTIs?

A
  • Renally cleared
  • Concentrate in urine (only cidal in UT)
  • Active in acidic pH
98
Q

What two organisms have built resistant against Nitrofurantoin? How do they do this?

A

Proteus organisms and Pseudomonas organisms

- Increase urine pH so abx is ineffective

99
Q

Which antibiotic turns urine brown?

A

Nitrofurantoin

100
Q

What antibiotic is associated with hemolytic anemia or G6PD deficiency in children?

A

Nitrofurantoin

101
Q

What antibiotic is associated with pulmonary fibrosis in the elderly?

A

Nitrofurantoin

102
Q

When taking Methenamine, what organ must be functioning properly? Why?

A

Need good liver function to properly eliminate ammonia

- Methenamine decomposes to formaldehyde and ammonia

103
Q

With use of Methenamine, if ammonia is not properly eliminated, what might this result in?

A

Encephalopathy (CNS side effects)

104
Q

What is the MOA for Bactrim?

A

Sulfamethoxazole + Trimethoprim target folic acid at two points in pathway (each drug works synergistically at each part of pathway)

105
Q

What are the three most significant toxicities associated with Sulfa drugs?

A
  • Hypersensitivity
  • SJS
  • Kernicterus
106
Q

What is the MOA for Daptomycin?

A

Binds to lipid bilayer and causes depolarization → cell death

107
Q

What is the MOA for Mupirocin?

A

Inhibits production of charged isoleucine transfer

108
Q

What is the primary application used for Mupirocin? What disease might it be used to treat?

A

Topical for nose or skin

- Can treat Impetigo

109
Q

What is the MOA for Polymyxins? What is their spectrum?

A

Binds to lipid A

- G- only because lipid A is only found on outer membranes which are only in G-

110
Q

What medication are Polymyxins often combined with?

A

Neomycin

111
Q

In what two populations are Tetracyclines contraindicated?

A
  • Pregnancy

- Children under 8

112
Q

In what population are Ketolides contraindicated?

A

Patients with Myasthesnia Gravis

113
Q

In what two populations are Fluoroquinolones contraindicated?

A
  • Pregnant

- Children under age 18 (due to cartilage erosion)

114
Q

In what two populations are Streptogramins contraindicated?

A
  • Pregnant/breastfeeding

- Children

Pharmacology I Exam #2 (5 decks)

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