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My Pharm II > Quiz 7 > Flashcards

Quiz 7 Flashcards

1
Q

Bacterial susceptibility is determined by the _____ around each disc.

A

radius

Disk diffusion technique

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2
Q

bacteriostatic (6) STECC

A
  • Sulfonamides
  • Tetracyclines
  • Erythromycin
  • Clindamycin
  • Chloramphenicol
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3
Q

Narrow spectrum ABX (3)

A
  • Penicillin G
  • Erythromycin
  • Clindamycin
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4
Q

concentration dependent ABX (2)

A
  • Aminoglycosides

- Flouroquinolones

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5
Q

Post-Antibiotic Effect (PAE):

A
  • Some antibiotics continue to suppress the growth of bacteria even after the antibiotic is no longer detectable
  • PAE demonstrated for virtually all antimicrobials
  • PAEs can be decreased in acidic (infected) media
  • During the PAE phase, bacteria are more susceptible to killing by leukocytes
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6
Q

All gram negative bacteria have resistance to __________.

A

vancomycin

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7
Q

Mechanisms of acquired resistance

A
  • Decreased permeability
  • Increased efflux pumps
  • Inactivation
  • Modification of the antimicrobial target
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8
Q

Look at slide 17

A

.

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9
Q

Need ___________ coverage for cutting through skin

A

Gram positive

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10
Q

Impaired host defenses

A

Anatomical (i.e. ulceration)

Secondary:

  • Neutropenia
  • Aspleenia
  • Malignancy
  • HIV
  • Immunosuppressant therapy
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11
Q

Pregnant Pharmacokinetics

A
  • Increased V.d (volume of distribution)

- Increased GFR

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12
Q

Ok in Preggos:

And if necessary?

A
  • PCN
  • Erythromycin
  • cephalosporins

If Necessary:

  • AminoGlycosides
  • Isoniazid
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13
Q

_________ in pregnant women is associated with acute fatty necrosis of the liver, pancreatitis, and possible renal injury.

A

Tetracycline

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14
Q

C. Diff: Pathogenesis is typically toxin-mediated with bacteremia extremely rare, what toxins?

A
  • Enterotoxin A

- Cytotoxin B

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15
Q

C. Diff Tx (2)

A
  • Oral vancomycin

- Dificid (fidaxomicin)- similar cure rates as vanco, reduced recurrence for moderate to severe infection

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16
Q

C.Diff and concurrent infections

A

-Continue C. difficile therapy also and extend the course for 5 to 10 days after the completion of the other antibiotics

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17
Q

Look at slide 37

A

.

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18
Q

Look at early C & S report, clusters usually _____

A

staph

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19
Q

ABX timing prior to incision?

  • Ancef
  • Vanco
A
  • Ancef 60 mins

- Vanco 120 mins

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20
Q

Vanco, ___ mg/kg actual body weight up to ______ mg

A

15

2500

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21
Q

Cell wall integrity

A

Beta Lactams

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22
Q

DNA synthesis

A

Flagyl

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23
Q

DNA gyrase

A

Quinilones

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24
Q

RNA Polymerase

A

Rifampin

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25
Q

Phospholipd Membranes

A

polymixins

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26
Q

Cell wall Synthesis (6)

A
  • D-Cycloserine
  • Vanco
  • Bacitractin
  • PCN
  • Cephalosporins
  • Cephamycins
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27
Q

Bind to the penicillin binding protein (PBP) due to similar structure to D-alanyl-D-alanine

A

Beta Lactams

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28
Q

What evolved to cause PCN resistance

A

Beta lactamase ring

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29
Q

Beta lactamase inhibitors (3), also called

A
  • Sulbactan
  • Tazobactam
  • Clavulanic Acid

“Suicide Inhibitors”

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30
Q

PCN facts: halflife, elimination

A

0.5-4 hours

Renal

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31
Q

PCN AE’s:

A

Jarisch-Herxheimer Rxn - releases toxins causing flu-like sx

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32
Q

MRSA and C.difficile rates are _____ in patients with reported PCN allergy.

A

higher

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33
Q

Amoxicillin halflife, elimination

A

1-3 hours

Renal

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34
Q

wide tissue distro including CNS when inflammed

A

Ampicillin

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35
Q

Covers Beta-lactimase enzyme

A
  • Oxacillin

- Need more here (*)

36
Q

wide distro including inflamed meninges

A
  • Nafcillin
  • Oxacillin
  • Dicloxacillin
37
Q

AE’s of Prolonged bleeding time, and Hypokalemia

A
  • Timentin

- Zosyn (neutropenia at high doses)

38
Q

Cafalosporins that cover MRSA Gen and type (2)

A

5th Gen

  • Ceftobiprole
  • Cefteroline
39
Q

Keflex/Ancef halflife, elimination, AEs. Does not cover?

A
  • Keflex 0.5 hours/Ancef 1.8 hours
  • Renal
  • Hypersensitivity rxns, CBC abnormalities, generally safe

Does not cover MRSA

40
Q

Difference in 3rd gen caphalosporins

A
  • Less gram positive activity
  • More gram positive activity
  • Anti-pseudomonal
  • Cross CNS (good for Meningitis)
41
Q

Elimination of 50% renal, sig biliary excretion

A

Cefoxatime

42
Q

“taz”manian devil, destroys everything

A

Ceftazidime (Fortaz)

43
Q

Ceftriaxone (rocephin): Penetration, elimination, AE

A

CSF penetration

Hepatic and Biliary

AE: Biliary sluding, precipitates with Ca in the IV

44
Q

3rd gen
4th gen
5th gen

Summaries

A

3rd gen - sees more resistance, not created equal

4th gen - can still kill off beta lactamase bacteria, still broad spectrum

5th gen - kills everything

45
Q

Carbapenems, covers? Seizure risks?

A
  • Covers Pseudomonas
  • High risk Seizures - Imipenem
  • Low risk seizures - Ertapenum
46
Q

IV vanco can still give someone C diff

A

.

47
Q

Vancomycin AE’s (4)

A

Redmans, Nephrotoxic, Ototoxic, Thrombocytopenia

48
Q

Vanco Random

A

Dosing based on trough levels

Red mans not true allergy, just infusion rate issue

Losing gram negative coverage on surgical prophylaxis, redose surgery lasting >16 hours

49
Q

Slows down ribosomal formation within bacteria

Gets inside and changes way protein interacts, slowly kills of bacteria

Covers?

A

Linezolid

Covers VRE

50
Q

Linezolid AEs

A

Myelosuppression (anemia, leukopenia, pancytopenia, thrombocytopenia)

51
Q

Linezolid (zyvox) drug interaction with*

A

MAO inhibitors, hold antidepressants during therapy

52
Q

Inhibits protein synthesis

A

Macrolides

53
Q
  • Half life = 68 hours long

- May prolong QT interval torsades

A

Azithromycin

54
Q

Best coverage of respiratory bugs

A

Azithromycin

55
Q

Significant GI toxicity, may prolong QT

A

Erythromycin

56
Q

AEs of Ketolides (4)

A
  • blurred vision
  • QT prolongation
  • N/V
  • LFT increase
57
Q

“I’m gonna be a floroquinolone and unzip your genes”

A

.

58
Q

Fluoroquinolones AEs (8)

A
  • arthropathies(*)
  • QT prolongations
  • CNS excitement
  • altered glucose homeostasis
  • seizure activity
  • agitation
  • confusion
  • achilles tendon rupture(*)
59
Q

DOC for bacterial GI infections (traveller’s)

A

Cipro

60
Q

Increased resistance due to efflux pumps

A

Cipro

61
Q

Best strep coverage

A

Moxifloxacin (Avelox)

62
Q

It is the first fluoroquinolone antibiotic with activity against methicillin-resistantStaphylococcus aureus(MRSA) and, unlike the other fluoroquinolones, is not associated with QT prolongation or photosensitivity

A

Delafloxacin

In addition to gram-positive organisms such as MRSA, delafloxacin targets gram-negative pathogens

63
Q

Bind irreversibly to the 30S ribosomal unit

A

Tetracyclines

64
Q

Teeth will be yellow forever, drug and age. Also?

A

Tetracyclines

(2nd/3rd trimester through the age of 8)

-Also, photosensitivity

65
Q

Drug interactions: Warfarin, PHT, CBZ, oral contraceptives

A

Doxycycline

66
Q

Similar to TCNs for TCN resistant bacteria

AE of?

A

Tigecycline

high incidence of N/V

67
Q

AE: prolongs NMBs, and? (2)

A

Aminoglycosides

Oto and Nephrotoxic

68
Q

When used for gram positive, use with a cell wall destruction agent (examples?)

A

Gentamycin

Ex: Cell wall synthesis and cell wall integrity agents: list….

69
Q

2 bacteriostatic = bactericidal, example? does what?

A

Bactrim (treats community MRSA)

decreases folic acid

70
Q

Alternative to Vanco for MRSA and VRSA

A

Bactrim

71
Q

Sulfa allergic cannot admin _________

A

bactrim

72
Q

Bactrim AEs (4)

A
  • pancytopenia
  • neutropenia
  • TTP
  • Stevens Johnson
73
Q

AEs: confusion, peripheral neuritis, pulmonary complications, hepatic damage, blood dyscrasias

A

Macrobid

74
Q

Can cause pulmonary fibrosis

A

Macrobid

75
Q

Highest C.diff risk(*)

A

Clindamycin (Cleocin)

(Also NMB

76
Q

Bacteria reductases reduce nitrofurantoin to reactive metabolites that inhibit bacterial citric acid cycle as well as DNA, RNA, and protein synthesis

A

Macrobid

77
Q

Reduced by the pyruvate: ferredoxin oxidoreductase system, decreasing intracellular conc of drug and promoting further diffusion into the cell; toxic/ short lived intermediateds and free oxygen radicals are formed; these toxic compounds interact with DNA causing strand breakage and helix unwinding, leading to cell death

A

Flagyl

78
Q

Disulfuram like rxns with EtOH? ANd interaction with?

A

Flagyl

Coumadin interactions

79
Q

AEs: Limb/muscle pain, myalgias, incrased CPK

A

Daptomycin

80
Q

Potent inducer of the CYP 450 system with significant interactions speed up meds half-life (2). How long?

A

Rifampin and Rifabutin

Can see drug interactions up to 3 months after DC

81
Q

AEs: hallucinations, tremors, agitation,

A

Acyclovir, valacyclovir

82
Q

Option for those unresponsive to previous agents (antivirals)

A

Foscarnet

83
Q

AEs of Amphoteracin B (2)

A
  • Renal Failure

- K and Mg wasting

84
Q

CYP3A4 inhibitor, prolongs drugs

A

Fluconazole

85
Q

AE of all the “-conazoles”

A

increase LFTs

My Pharm II (8 decks)

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