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Unit 2- Pharm > Red/Bolded Words/Review Deck 2 > Flashcards

Red/Bolded Words/Review Deck 2 Flashcards

1
Q

When you add a beta lactamase inhibitor to one of the four penicillins they can combine with, what are you doing?

A

Extending the spectrum

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2
Q

Cephalosporins are another class of:

A

beta lactams

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3
Q

Beta lactamase inhibitors cannot be added to

A

natural penicillins

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4
Q

1st generation cephalosporins closely resemble:

A

natural penicillins

good G+ activity

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5
Q

Cephalexin and cefazolin

A

1st generation cephalosporins

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6
Q

DOFC for surgery prophylaxis (cephalosporin)

A

Cefazolin - pareneteral/penicillinase resistant/cidal/good half life

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7
Q

2nd generation cephalosporins have less gram ____ activity than first generation cephalosporins and greater gram ___ activity than first generation cephalosporins

A

positive

negative

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8
Q

Cefaclor, Cefuroxime, Cefprozil are what generation of cephalosporins?

A

2nd generation

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9
Q

What are 2nd generations cephalosporins?

A

cefaclor, cefuroxime, cefprozil

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10
Q

Of the 2nd generation cephalosporins, which is parenteral?

A

Cefuroxime

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11
Q

Ceftriaxone - DOFC for which two diseases?

A

Lyme Disease

Gonorrhea

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12
Q

Which 3rd generation cephalosporins (2) has CNS penetration?

A

Ceftriaxone, Cefotaxime Sodium

Do not need inflammation to be present in order to penetrate CNS

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13
Q

Which of the third generation cephalosporins is oral?

A

Cefixime

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14
Q

Why are natural penicillins DOC for Neisseria Meningitis?

A

CNS PENETRATION OCCURS ONLY WITH INFLAMMATION

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15
Q

Which third generation cephalosporin has good pseudomonas coverage?

Is it DOFC? If no, what is?

Why would you use cefazidime over the DOFC?

A

Ceftazidime

No.

Anti-pseudomonal penicillins

Penicillin allergy

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16
Q

Ceftriaxone - important adverse effect?

A

bilirubin displacement - why you do not give to neonates

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17
Q

Cefepime is what generation cephalosporin?

A

4th generation

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18
Q

Which cephalosporin has the broadest coverage?

A

Cefepime - enterobacteriaceae, MSSA, psuedomonas

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19
Q

When would you use cefepime?

A

Empirical therapy - especially when resistance to beta-lactamase is anticipated

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20
Q

5th generation cephalosporin?

A

Ceftaroline

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21
Q

Ceftaroline has what kind of coverage?

What does it NOT have?

A

MRSA and VRAS coverage - only beta lactam active against MRSA

Does NOT have anti-pseudomonal activity

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22
Q

What kind of reaction occurs with cephalosporins?

A

Disulfiram-like reaction after alcohol consumption - do not drink alcohol!

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23
Q

Do not give what group of drugs if pt has a penicillin allergy? Why?

A

Cephalosporins unless in clinical setting because there is a 10% cross-sensitivity with penicillin

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24
Q

3rd and 4th generation cephalosporins have this particular GI side effect

A

diarrhea

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25
Q

One of the most concerning side effects of cephalosporins is?

A

Nephrotoxicity - synergistic with aminoglycoside

IF kidney problems - do not use cephalosporins

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26
Q

Monobactam drug

A

Aztreonam

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27
Q

Monobactams are active against

A

aerobic G- rods (including pseudomonas, Serratia, Kiebsiellas, Proteus)

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28
Q

Aztreonam is/is not a beta lactam

A

it is a beta lactam

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29
Q

Aztreonam is administered how

A

parenterally

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30
Q

Aztreonam does or does not have cross sensitivity with other beta-lactams (including penicillin)

A

Does not

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31
Q

What are the three carbapenems?

A

Imipenem and Cilastin (given together)

Meropenem

Ertapenem

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32
Q

Carbapenems have what kind of spectrum

A

BROAD

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33
Q

Carbapenems are good for what kind of infections?

A

mixed

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34
Q

Imipenem can cause:

If pt has previous history of this OR of renal failure, what other carbapentem can you use?

A

seizures

Meropenem

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35
Q

Which of the carbapenems should we not use for pseudomonas infections?

A

Ertapenem

36
Q

Is Vancomycin a beta lactam? An inhibitor of cell wall synthesis?

A

No - not a beta lactam

Yes - inhibitor of cell wall synthesis

37
Q

How does Vancomycin work?

A

prevents transpeptidtion of peptidoglycan chain by binding to terminal D-ala-D-ala

38
Q

Vancomycin: cidal or static

A

cidal

39
Q

How does vancomycin resistance occur?

A

D-ala changed to D-lactate and Vanco can no longer bind

40
Q

Vancomycin is DOC for:

It is a drug of least resort due to emergence of VRE

A

MRSA

41
Q

For C. Diff infections - how must vanco be administered?

A

ORALLY - only way it will work on that infection!

42
Q

3 adverse effects of vancomycin

A

Ototoxicity

Nephrotoxicity

Red man syndrome - from histamine release

43
Q

Fosfomycin is a

A

inhibitor of cell wall synthesis

44
Q

How does fosfomycin work?

A

inhibits cell wall synthesis early - prevents NAG to NAM reduction

45
Q

Fosfomycin used for:

Is it first or second line drug?

A

UTIs uncomplicated

NO

46
Q

Bacitracin - inhibitor of cell wall synthesis?

A

Yes

47
Q

Bacitracin inhibits cell wall synthesis how?

A

interferes with final dephosphorylation step in phospholipid carrier cycle - cannot transfer NAG-NAM across inner membrane

48
Q

Bacitracin targets gram (_) bacteria

A

positive

49
Q

What is bacitracin commonly used with?

A

neomycin and polymyxin - both active against gram -

good spectrum of gram - and gram + drugs

50
Q

Why is bacitracin not used parenterally?

A

nephrotoxicity

51
Q

How is bacitracin usually administered?

A

topically

52
Q

Majority of drugs that inhibit protein synthesis target what robosomal subunit:

Majority are Cidal or static?

A

50s

Static

53
Q

What are the exceotions to the 50S target?

A

aminoglycosides

tetracyclines

54
Q

Which of the protein synthesis inhibitors are CIDAL? These are the exceptions!

A

aminoglycosides

Dalfopristin, Quinupristin (Synercid)

55
Q

Why are dalfopristin and quinupristin cidal?

A

Synergistic effect - two drugs always given together

56
Q

3 macrolides

A

erythromicin, clarithromycin, azithromycin

57
Q

Which of the macrolides is ONLY oral?

A

Clarithromycin

58
Q

What is the main spectrum of macrolides?

A

Mainly G+

59
Q

Macrolides have similar spectrum as:

Makes for a great alternate if?

As long as:

A

Penicillins

Penicillin allergy

Immunocompetent

60
Q

Clarithromycin + Omeprazole (+ ampicillin) is great for treating

A

H. pylori

61
Q

Macrolides are DOFC for:

A

Mycoplasmal pneumonia, Chlamydia trachomotis, C. pneumonia, Legionella

62
Q

Mechanims for resistance against macrolides? (2)

A

Efflux pumps

Methylation of drug binding site

63
Q

Macrolides have the most GI intolerance (diarrhea)?

A

Erythromycin

64
Q

Drug interactions of macrolides

What two drugs in macrolide class are known for drug interactions?

A

inhibits CYP3A4

IF looking for a drug with no drug interactions - do not look at erythromycin or clarithromycin

65
Q

Which macrolide has no drug interactions?

A

Azithromycin

66
Q

Which macrolide affects QT prolongation the most? Chance for torsades

A

Azithromycin

All three are concerning with this side effect, but Azithro is the worst.

67
Q

Order of macrolides for worst GI intolerance to best?

A

Erythromycin, Azithromycin, Clarithromycin

68
Q

Name of ketolide?

A

Telithromycin

69
Q

Why is telithromycin stronger than macrolides?

A

Bind tightly to two sides on ribosomal RNA

70
Q

What is very concerning about telithromycin?

A

Hepatotoxic

71
Q

Why do you even look at telithromycin?

Is it DOFC?

A

community acquired pneumonia

STILL NOT DRUG OF FIRST CHOICE

72
Q

Clindamycin can be administered how?

A

parenteral, oral, topical

73
Q

Clindamycin has what kind of spectrum?

A

Broad

74
Q

What two specific diseases did we discuss relating to clindamycin?

A

Toxic Shock Syndrome and Osteomyelitis

75
Q

Clindamycin can penetrate what?

A

bones - makes it good for osteomyelitis

76
Q

Why are protein synthesis inhibitors used for toxic shock syndrome?

A

because you want to stop the protein syntheis (which makes the toxins) and then lyse the cell. If you lyse it first, the toxins will pour out into blood worsening the infection

77
Q

Clindamycin promotes overgrowth of

A

C.diff - depending on length of tx and sensitivity of pt

78
Q

C. diff overgrowth results in

A

Pseudomembranous colitis

79
Q

What do you do if pt has c.diff?

A

stop clindamycin and prescribe ORAL vancomycin

80
Q

Dalfopristin and Quinupristin make up

A

Synercid

81
Q

What is unique about Synercid?

A

synergistic between dalfopristin and quinupristin – when together, they become CIDAL and target 50S ribosome

82
Q

When would you consider using synercid?

A

Gram positive aerobic infections AND drug-resistant infections (alternate to Vanco for MRSA)

83
Q

Why is synercid contraindicated in breast-feeding, children, hepatic disease, pregnancy, streptogramin hypersensitivity?

A

Because it is a new drug - we have no clue how it will affect those with these conditions

84
Q

Linezolid is good for gram (__) infections

A

gram positive infections

85
Q

Linezolid inhibits

A

monoamine oxidation

86
Q

What are the main two reasons you would NOT prescribe linezoild?

Why?

A

pheochromocytoma

SSRIs/antidepressent

Can get toxicities from hyperelevating monoamines

Unit 2- Pharm (9 decks)

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