Meds

Question 1

Quinolones

Answer 1

Bacteriacidal inhib DNA syn b/c promote DNA gyrase/topoisomerase4 cleave of DNA

2nd gen Ciprofloxacin: works on DNA gyrase against GNB pseudomonas aeruginosa, bacillus anthracis

3rd gen Levofloxacin: works on topoisom4 on GNB and GramPos!
3rd gen Mocifloxacin: works on Topoisom4 on mostly GramPos BUT doesn’t work on UTI

Concentration-dependent killing
Works on UTI, prostatitis, community acquired pneumonia (except Cipro!!)

Can cause arthropathy jt probs in pregnancy, tendinitis

Question 2

Aminoglycosides

Answer 2

Bacteriacidal inhib 30s ribosome translation initiation, elongation, and can induce incorp of wrong aa! Only for use in serious case, last resort.

Gentamicin, Amikacin, Streptomycin (TB), Neomycin (topical for GI)
Use against GNB
Highly ionized, not metabolized
Lesser concentration in CNS

Lots of bac resistance
Lots of side effects
-ototoxicity- CN8 auditory, vestibular
-nephrotoxicity- most common cause of drug induced renal failure
-neuromuscular blockade

Question 3

Bactrim TMP/SMX

Trimethoprim Sulfamethoxazole

Answer 3

TMP inhibs DHFR, SMX inhibs PABA addition onto folic acid: ie together inhib folate synthesis (hence DNA purine etc syn)

Goes into CNS and sputum rly well
Cause rash
Don’t give in late pregnancy- cause jaundice hyperbilirubinemia

Can also use for otitis media, MRSA

Question 4

Metronidazole Flagyl

Answer 4

Prodrug activated in susceptible bac usu anaerobes and protozoa like giardia lamblia, hemolyticus, trichomonas

Metallic taste and urine color change
Disulfiram alcohol rxn
Nausea, headache

Question 5

Nitrofurantoin Macrodantin

Answer 5

Susceptible only if can reduce Nitrofurantoin into a DNA-damaging component

Only EColi and enterococci susceptible
Brown urine

For treat and prevent UTI

Question 6

Fosfomyl Trometamol

Answer 6

PEP analog that inhibs enolpyruvate transferase so cannot make N-acetylmuramic bac cell wall

Single dose treat uncomplicated UTI