Macrolides

Question 1

Macrolides inhibit protein synthesis by

Answer 1

reversibly binding to bacterial 50s ribosomal subunit so amino acids are unable attach to the ribosomes making it impossible for translation to occur

Question 2

Macrolides cover Gram positive organisms such as___(6) and gram negative organisms such as ___(8)

Answer 2

+: staph, strep, cornybacteria, mycoplasma, legionella, listeria
-: neisseria, bordetella, baronella, treponema, campylobacter, H. pylori, H. flu, M. cat

Question 3

Macrolides have two serious adverse reactions which are ____

Answer 3

Long Q-T and Stevens johnson syndrome

Question 4

What percent of strep pneumo isolates are macrolide resistant?

Answer 4

41%

Question 5

Name the 4 mechanisms in which bacteria are becoming resistant to macrolides

Answer 5

1. Reducing cell membrane permeability
2. Efflux of the antibiotic
3. Hydrolysis by esterases (enterobacter)
4. Modification of the binding sites so macrolides can’t bind

Question 6

Macrolides have promotility properties which means they can be uses to _____ and can be used for _____

Answer 6

stimulate motilin receptors (increase gastric contractions and stimulate gastric emptying) ; gastroparesis

Question 7

The D-test shows if ________

Answer 7

Erythromycin has induced clindamycin resistance

Question 8

Erythromycin is bacterio____ and a strong _____ inhibitor

Answer 8

stasis (can be static or cidal depending on concentration); P450

Question 9

Erythromycin is strongly indicated to use in patients who have ______ and _____

Answer 9

pertussis; in adults who have camplyobacter infection (second line)

Question 10

The 5 things we want to ask our patients before we prescribe them erythromycin are:

Answer 10

1. allergies
2. pregnancy status
3. liver status
4. cardiac status
5. other meds

Question 11

The salt forms of erythromycin have better______ compared to the base form

Answer 11

GI absorption

Question 12

Clarithromycin is a _____ macrolide that is used first line for _____ and second line for _____. It also is the drug of choice for _____ along with azythromycin.

Answer 12

synthetic, pertussis, AOM, MAC in HIV pts

Question 13

The most important contraindication we have for clarithromycin is_____

Answer 13

to not give it to pts who have congentitial long Q-T (riskiest drug for long Q-T)

Question 14

Clarithromycin is a pregnancy category ____ drug and has greater ____ and _____ than erythromycin. It also has a longer____ than erythromycin which means less dosing.

Answer 14

C, activity, oral absorption, half life

Question 15

Azythromycin is a pregnancy category ___ drug that requires some ____ monitoring

Answer 15

B, liver

Question 16

Fidaxomicin can be used for ____ when other tx have failed

Answer 16

c. diff

Question 17

Generally speaking, macrolides are great for patients who have:

Answer 17

CAP (1st line for outpatient) and other respiratory infections
Chlamydia
Pertussis
Diphtheria
Acute exacerbations of chronic bronchitis

Question 18

Macrolides can be used prophylactically for (2)

Answer 18

Endocarditis prophylaxis in dental procedures

Rheumatic fever prophylaxis (erythromycin DOC in PCN allergic pts)