Pharm antimicrobials 3

Question 1

what are the nucleic acid synthesis inhibitors?

Answer 1

fluoroquinolones, metronidazole, rifamycin

Question 2

what are the fluoroquinolones

Answer 2

-floxacin

ciprofloxacin, levofloxacin, moxifloxacin

Question 3

fluoroquinolones mechanism

Answer 3

FLOCK OF SINNERS

• gyrating (inhibit DNA gyrase - topoisomerase II and IV)
• bactericidal

Question 4

what must fluoroquinolones not be taken with?

Answer 4

antacids (divalent cations chelate oral quinolones_

Question 5

fluoroquinolones spectrum

Answer 5

gram - rods of urinary and GI tracts including pseudomonas, neisseria, intracellulars, also some gram + (bug that would ruin a party! bring the party inside!) STDs, UTIs, GI and ab infections

Question 6

side effects of fluoroquinolones

Answer 6

GI irritibility - vomiting, diarrhea (hang over), superinfections, skin rashes, headache, dizziness, tendonitis, prolonged QT

Question 7

who is fluoroquinolones contraindicated in? why?

Answer 7

children and pregnant - hurt attachments to bones - damage cartilage (CHILDREN AND PREGNANT CAN’T DRINK!)

Question 8

what are the only oral agents effective against pseudomonas?

Answer 8

levofloxacin and ciprofloxacin

Question 9

metronidazole mechanism

Answer 9

forms toxic free radicals in bacterial cell that damage DNA - bactericidal, antiprotozoal

Question 10

metronidazole spectrum

Answer 10

anaerobes BELOW the diaphragm - excluding actinomycetes and peptostreptococcus (get on the METRO with METROnidazole!)
covers C difficile!
also covers the protozoa (trichomonas, giardia, entamoeba histolytica)

Question 11

what are the two drugs that cover c difficile?

Answer 11

metronidazole or vancomycin

Question 12

what is used in triple therapy against h pylori?

Answer 12

metronidazole, clarithromycin, proton pump inhibitor

Question 13

metronidazole side effects

Answer 13

disulfiram-like reaction (severe flushing, tachycardia, hypotension) with alcohol; headache, metallic taste

Question 14

what are the rifamycins?

Answer 14

RIF-

rifampin, rifabutin, rifaximin

Question 15

rifamycins mechanism

Answer 15

inhibit DNA-dependent RNA polymerase (inhibit RNA synthesis)

Question 16

rifamycin spectrum

Answer 16

mycobacterium mostly, also gram + and gram - as adjunctive therapy

Question 17

what are the 4 Rs of rifamycins?

Answer 17

1. RNA polymerase inhibitor
2. Ramps up microsomal cytochrome P-450 (BUT rifaBUTin does not)
3. Red/orange body fluids
4. Rapid resistance if used alone

Question 18

rifamycin side effects

Answer 18

minor hypatotoxicity and drug interaction, orange body fluids

Question 19

which rifamycin is preferred in HIV infection?

Answer 19

rifabutin! (less P-450)

Question 20

what are the antituberculosis drugs?

Answer 20

isoniazid, pyrazinamide, ethambutol, rifamycins

Question 21

isoniazid mechanism

Answer 21

inhibition of mycolic acid synthesis (large fatty acid in cell wall of mycobacteria)

Question 22

what is the only agent used as solor prophylaxis against TB? and monotherpay for latent TB?

Answer 22

isoniazid for both

Question 23

isoniazid side effects

Answer 23

hepatotoxicity, p-450 inhibition, drug induced SLE, vitamine B6 deficiency

Question 24

what needs to be administered with isoniazid?

Answer 24

vit B6

Question 25

pyrazinamide mechanism

Answer 25

unknown - prodrug that works best at acidic pH

Question 26

pyrazinamide side effects

Answer 26

hyperuricemia, hypatotoxicity

Question 27

which TB drug works the quickest for killing?

Answer 27

pyrazinamide

Question 28

ethambutol mechanism

Answer 28

decreased carbohydrate polymerization of mycobacterium cell wall by blocking arabinosyltransferase

Question 29

ethambutol side effects

Answer 29

neuropathy and optic neuritis (reversible)

Question 30

what are the folic acid synthesis and reduction drugs?

Answer 30

sulfonamides and trimethoprim

Question 31

sulfamethoxazole mechanism

Answer 31

inhibit dihydropteroate synthase which inhibits folate synthesis - bacteriostatic

Question 32

when does sulfamethoxazole become bacteriocidal?

Answer 32

when combined with trimethoprim (act synergistically)

Question 33

sulfamethoxazole spectrum

Answer 33

gram +, gram 0, nocardia, chlamydia - uncomplicated UTIs, pneumocystis pneumonia and toxoplasmosis

Question 34

when is the trimethoprim/sulfamethoxazole combindation (bactrim) dangerous to give?

Answer 34

when taking warfarin because causes increased warfarin = increased risk of bleeding

Question 35

sulfamethoxazole side effects

Answer 35

allergies,displace other drugs from albumin (warfarin)

Question 36

trimethoprim mechanism

Answer 36

inhibits bacterial dihydrofolate reductase - bacteriostate

Question 37

trimethoprim spectrum

Answer 37

UTIS, shigella, salmonella, pneumocystis jirovecii, pneumonia treatment and prophylaxis, toxoplasmosis

Question 38

TMP/SMX bactrim use

Answer 38

TMPS:

T = resp tree; M = mouth, gram - GI tract; P = pee (UTI); S = syndrome - AIDS prevents PCP when CD4 under 200

Question 39

trimethoprim side effects

Answer 39

megaloblastic anemia, leukopenia, granulocytopenia - TMP = treats marrow poorly
Hyperkalemia in patients with renal failure