Pharmacy

Question 1

Outpatient tx in healthy patient w/out comorbidities for CAP

Answer 1

Macrolides:
Azithromycin
Clarithromycin
Erthyromycin

Question 2

What are the side effects of ACE inhibitors?

Answer 2

Sudden or new onset of dry cough w/out signs of common cold

Rare but life-threatening:
ANGIOEDEMA

Question 3

side effects of hydrochlorothiazide (HCTZ) or thiazide diuretics

Answer 3

hyperuricemia
hyperglycemia

Question 4

side effects of CCBs

Answer 4

swollen ankles
HA

Question 5

Name the antibiotics that cover only gram + organisms

Answer 5

GLAM
Glycopeptides
Licosamides
Aminoglycosides
Macrolides

Question 6

Of the GLAM abx, which covers only gram (-) organisms?

Answer 6

Aminoglycosides

Question 7

What is the suffix of aminoglycosides?

Answer 7

mycin/micin

Question 8

Examples of aminoglycosides

Answer 8

streptomycin
tobramycin (Nebcin)
amikacin (Amikin)
Netilmicin (Netromycin)
Neomycin
Kanamycin (Kantrex)
gentamycin

STANNK-G

Question 9

What is the MOA for aminoglycosides?

Answer 9

Binding to the aminoacyl site of 16S ribosomal RNA w/in the 30S ribosomal subunit, leading to misreading of the genetic code and inhibition of translocation.

cause production of abnormal proteins secondary to misreading of genetic code

ALL are bactericidal even after serum levels have dropped below the bactericidal concentration (PAE)

The ensuing antimicrobial activity is usually bactericidal against susceptible aerobic GRAM - NEGATIVE bacilli.

Amikacin least likely to induce resistance.

Question 10

Which organisms do AMINOGLYCOSIDES work against?

Answer 10

E. Coli
K pneumoniae
S. marcecens
P mirabilis
P. aeruginosa

Question 11

What are the side effects and toxicities of Aminoglycosides?

Answer 11

1. NEPHROTOXICITY: damage proximal renal tubule cells = acute renal failure
   sx:
   - proteinuria
   - casts in urine
   - elevated serum creatinine
   - elevated BUN
   - production of dilute urine

Reversible upon DC of drug

Monitor trough levels 2 and 12 hours after dosing in patients getting these drugs once a day.

2. NEUROMUSCULAR BLOCKADE.
   - do not use with MYASTHENIA GRAVIS.
3. OTOTOXICITY: damage hearing and balance secondary to elevated trough levels and maybe IRREVERSIBLE.
   1st sign of COCHLEAR damage = high-pitched tinnitus
   1st sign of VESTIBULAR damage = HA

Question 12

Which abx interrupt bacterial nucleic acid synthesis or bactericidal?

Answer 12

Fluoroquinolones

Question 13

MOA of fluoroquinolones

Answer 13

Inhibit bacterial DNA GYRASE so that DNA cannot be supercoiled

Question 14

MOA of metronidazole/tinidazole

Answer 14

BREAKS DNA strands and inhibits DNA synthesis

Question 15

What are the use of fluoroquinolones?

Answer 15

Broad spectrum abx

bone and soft tissue infections

UTIs

Respiratory tract infections

GI infections

prevention of anthrax

Question 16

Name fluoroquinolones

Answer 16

Ciprofloxacin (Cipro)

Ofloxacin (Floxin)

Lomefloxacin (Maxaquin)

Sparfloxacin (Zagam)

Moxifloxacin (Avelox)

Gemifloxacin (Factive)

Norfloxacin (Noroxin)

Levofloxacin (Levaquin)