Pharmacology

Question 1

Cell wall synthesis inhibitors

Answer 1

Beta lactams
Glycopeptides
Daptomycin

Question 2

Modifiers of DNA / nucleic acid synthesis

Answer 2

Fluoroquinolones

Metronidazole

Question 3

Modifiers of protein synthesis

8

Answer 3

Tetracycline
Macrolides/Ketolides
Aminoglycosides 
Chloramphenicol 
Quinupristin/Dalfopristin
Clindamycin
Linezolid
Glycylcycline

Question 4

Modifiers of energy metabolism

Answer 4

Sulfamethoxazole/Trimethoprim

SMX/TMP

Question 5

What is the best route for concentration independent killers? Why?

Answer 5

Continuous IV

Needs the most time above the MIC

Question 6

What is the best route for concentration dependent killers?

Answer 6

Largest dose without toxicity

Given once

Question 7

Beta lactams

Answer 7

Penicillins
Cephalosporins
Carbapenems
Monobactams

Question 8

This class of drugs binds to the PBP

Answer 8

Beta lactams

Question 9

What are beta lactamases?

What produces them?

Answer 9

Enzymes secreted by bacteria
Gram -
Staph

Question 10

Beta lactamase inhibitors

Answer 10

Clavulanate
Sulbactam
Tazobactam

Question 11

Natural penicillins are used for__

Answer 11

Group A strep

Question 12

Aminopenicillins are used for__

Answer 12

Enterococcus faecalis
Strep pneumoniae (high dose!!)

Question 13

Penicillinase resistant penicillins include:

Answer 13

Dicloxacillin (oral)
Oxacillin (IV)
Nafcillin (IV)
Methicillin (IV)

Question 14

What is the drug of choice for non-MRSA staph aureus infections?

Answer 14

Penicillin

Question 15

What beta lactams/beta lactamase inhibitor combo is mostly used?
When is it used?

Answer 15

Piperacillin / Tazobactam

Used when pseudomonas is suspected
Broad spectrum

Question 16

In general, lower generations of cephalosporins have better ___ coverage.

Higher generations have better ___ coverage.

Answer 16

Gram +

Gram -

Question 17

First generation cephalosporins are active against __

Answer 17

Gram + aerobes
MSSA
E. coli

Question 18

Second generation cephalosporins Example?

Answer 18

Cefoxitin is active against Bacteroides and Clostridium
BUT NOT C. diff

This is the only one that is below the diaphragm

Question 19

Third generation cephalosporins

Example?

Answer 19

Mostly gram -
Don’t usually use for gram +

Ceftazidime is the ONLY third gen that can cover pseudomonas

Question 20

Fourth generation cephalosporins

Example?

Answer 20

Gram -
Stability against beta lactamases
Cefepime

Question 21

Fifth generation cephalosporins

Example?

Answer 21

Ceftaroline is the only beta lactam that covers MRSA

it can attach to the altered PBP

Question 22

What gen of cephalosporins is Cefepime?

Answer 22

4th

Question 23

What gen of cephalosporins is Ceftazidime?

Answer 23

3rd

Question 24

What gen of cephalosporins is Ceftaroline?

Answer 24

5th

Question 25

What gen of cephalosporins is Cefoxitin?

Answer 25

2nd

Question 26

What are the broadest spectrum antibiotics we have?

Answer 26

Carbapenems

Question 27

What is NOT covered by carbapenems?

Answer 27

MRSA C. diff Ertapenem does not cover pseudomonas but the other 3 do

Question 28

List of carbapenems

Answer 28

Ertapenem Meropenem Imipenem-cilastatin Doripenem

Question 29

Aztreonam is a __ | 4 key points

Answer 29

Monobactam IV only Covers pseudomonas Can be safely used in people w/penicillin allergies Gram - only

Question 30

Glycopeptides:

Answer 30

Vancomycin and its copy cats: Televancin Oritavancin Dalbavancin

Question 31

Coverage of vancomycin

Answer 31

Gram + only Staph aureus -MRSA -MSSA but use beta lactam first! C. diff (ORAL ONLY)

Question 32

Dosage for vancomycin is based on ___

Answer 32

Kidney function

Question 33

ADE for vancomycin

Answer 33

Red man syndrome | IV related

Question 34

ADE for televancin

Answer 34

Foamy urine | Metallic taste

Question 35

Daptomycin only covers ___ bacteria. | You cannot use it for ___ because ___

Answer 35

Gram + Pneumonia It is inactivated by lung surfactant

Question 36

Tetracyclines

Answer 36

Doxycycline Minocycline (acne) Tetracycline (not really used)

Question 37

Doxycycline covers ___

Answer 37

Gram + aerobes -staph aureus (MSSA/MRSA) Gram - aerobes but resistance is common Atypical bacteria

Question 38

Doxycycline can interact with ___ ADE?

Answer 38

Divalent and trivalent cations GI symptoms Nausea Vomiting Diarrhea

Question 39

Glycylcycline example?

Answer 39

Tigecycline Limited to severe infections

Question 40

Macrolides/Ketolides

Answer 40

Erythromycin Calrithromycin Azithromycin *

Question 41

Macrolides/Ketolides spectrum

Answer 41

``` S. pneumoniae H. influenzae M. catarrhalis Atypicals Mycobacterium ```

Question 42

ADE for macrolides/ketolides

Answer 42

QTc prolongation Nausea Vomiting Diarrhea *Black Box Warning

Question 43

Aminoglycosides key points | 4

Answer 43

Usually only gram - Only IV only hospital settings Severe infections

Question 44

Aminoglycosides are ___ and ___

Answer 44

Bactericidal and concentration dependent

Question 45

Aminoglycosides spectrum

Answer 45

Enterococcus - synergy Gram - aerobes *rarely monotherapy

Question 46

Aminoglycosides absorption

Answer 46

Poor GI absorption No oral options Dosage based on kidney function

Question 47

ADE of aminoglycosides

Answer 47

Nephrotoxicity | Ototoxicity

Question 48

Clindamycin spectrum

Answer 48

Gram + and - aerobes Staph aureus including MRSA Anerobes

Question 49

What is the most common cause of antibiotic associated C. diff?

Answer 49

Clindamycin

Question 50

Linezolid spectrum

Answer 50

Useful for MRSA | Gram + only

Question 51

ADE of linezolid

Answer 51

Myelosuppression with >2 weeks use Monoamine oxidase inhibition -should not be used with MAOIs and SSRIs

Question 52

What are the 3 Fluoroquinolones?

Answer 52

Ciprofloxacin Moxifloxacin Levofloxacin

Question 53

Fluoroquinolones spectrum

Answer 53

``` Gram + and - Enterobacteriaceae Atypicals MSSA AVOID IN MRSA (resistance induced) ``` ``` Strep pneumoniae (except ciprofloxacin) Pseudomonas (except moxifloxacin) ```

Question 54

ADE of fluoroquinolones

Answer 54

QTc prolongation Can interact with divalent and trivalent cations

Question 55

QTc prolongation is an ADE for ___ and ___

Answer 55

Macrolides/Ketolides Fluoroquinolones

Question 56

Metronidazole spectrum

Answer 56

Anaerobic Bacteroides C. diff

Question 57

Metronidazole can interact with __

Answer 57

Ethanol

Question 58

Sulfamethoxazole/Trimethoprim inhibits___

Answer 58

Folate synthesis

Question 59

SMX/TMP covers ___

Answer 59

MRSA

Question 60

What drug requires dosage adjustment when CrCl <30ml/min?

Answer 60

SMX/TMP

Question 61

ADE of SMX/TMP

Answer 61

Leukopenia Thrombocytopenia Eosinophilia Epidermal necrolysis Steven's-Johnson Crystalluria