Red/Bolded Words/Review Deck 2

Question 1

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

Answer 1

Extending the spectrum

Question 2

Cephalosporins are another class of:

Answer 2

beta lactams

Question 3

Beta lactamase inhibitors cannot be added to

Answer 3

natural penicillins

Question 4

1st generation cephalosporins closely resemble:

Answer 4

natural penicillins

good G+ activity

Question 5

Cephalexin and cefazolin

Answer 5

1st generation cephalosporins

Question 6

DOFC for surgery prophylaxis (cephalosporin)

Answer 6

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

Question 7

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

Answer 7

positive

negative

Question 8

Cefaclor, Cefuroxime, Cefprozil are what generation of cephalosporins?

Answer 8

2nd generation

Question 9

What are 2nd generations cephalosporins?

Answer 9

cefaclor, cefuroxime, cefprozil

Question 10

Of the 2nd generation cephalosporins, which is parenteral?

Answer 10

Cefuroxime

Question 11

Ceftriaxone - DOFC for which two diseases?

Answer 11

Lyme Disease

Gonorrhea

Question 12

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

Answer 12

Ceftriaxone, Cefotaxime Sodium

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

Question 13

Which of the third generation cephalosporins is oral?

Answer 13

Cefixime

Question 14

Why are natural penicillins DOC for Neisseria Meningitis?

Answer 14

CNS PENETRATION OCCURS ONLY WITH INFLAMMATION

Question 15

Which third generation cephalosporin has good pseudomonas coverage?

Is it DOFC? If no, what is?

Why would you use cefazidime over the DOFC?

Answer 15

Ceftazidime

No.

Anti-pseudomonal penicillins

Penicillin allergy

Question 16

Ceftriaxone - important adverse effect?

Answer 16

bilirubin displacement - why you do not give to neonates

Question 17

Cefepime is what generation cephalosporin?

Answer 17

4th generation

Question 18

Which cephalosporin has the broadest coverage?

Answer 18

Cefepime - enterobacteriaceae, MSSA, psuedomonas

Question 19

When would you use cefepime?

Answer 19

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

Question 20

5th generation cephalosporin?

Answer 20

Ceftaroline

Question 21

Ceftaroline has what kind of coverage?

What does it NOT have?

Answer 21

MRSA and VRAS coverage - only beta lactam active against MRSA

Does NOT have anti-pseudomonal activity

Question 22

What kind of reaction occurs with cephalosporins?

Answer 22

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

Question 23

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

Answer 23

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

Question 24

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

Answer 24

diarrhea

Question 25

One of the most concerning side effects of cephalosporins is?

Answer 25

Nephrotoxicity - synergistic with aminoglycoside IF kidney problems - do not use cephalosporins

Question 26

Monobactam drug

Answer 26

Aztreonam

Question 27

Monobactams are active against

Answer 27

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

Question 28

Aztreonam is/is not a beta lactam

Answer 28

it is a beta lactam

Question 29

Aztreonam is administered how

Answer 29

parenterally

Question 30

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

Answer 30

Does not

Question 31

What are the three carbapenems?

Answer 31

Imipenem and Cilastin (given together) Meropenem Ertapenem

Question 32

Carbapenems have what kind of spectrum

Answer 32

BROAD

Question 33

Carbapenems are good for what kind of infections?

Answer 33

mixed

Question 34

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

Answer 34

seizures Meropenem

Question 35

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

Answer 35

Ertapenem

Question 36

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

Answer 36

No - not a beta lactam Yes - inhibitor of cell wall synthesis

Question 37

How does Vancomycin work?

Answer 37

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

Question 38

Vancomycin: cidal or static

Answer 38

cidal

Question 39

How does vancomycin resistance occur?

Answer 39

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

Question 40

Vancomycin is DOC for: It is a drug of least resort due to emergence of VRE

Answer 40

MRSA

Question 41

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

Answer 41

ORALLY - only way it will work on that infection!

Question 42

3 adverse effects of vancomycin

Answer 42

Ototoxicity Nephrotoxicity Red man syndrome - from histamine release

Question 43

Fosfomycin is a

Answer 43

inhibitor of cell wall synthesis

Question 44

How does fosfomycin work?

Answer 44

inhibits cell wall synthesis early - prevents NAG to NAM reduction

Question 45

Fosfomycin used for: Is it first or second line drug?

Answer 45

UTIs uncomplicated NO

Question 46

Bacitracin - inhibitor of cell wall synthesis?

Answer 46

Yes

Question 47

Bacitracin inhibits cell wall synthesis how?

Answer 47

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

Question 48

Bacitracin targets gram (_) bacteria

Answer 48

positive

Question 49

What is bacitracin commonly used with?

Answer 49

neomycin and polymyxin - both active against gram - good spectrum of gram - and gram + drugs

Question 50

Why is bacitracin not used parenterally?

Answer 50

nephrotoxicity

Question 51

How is bacitracin usually administered?

Answer 51

topically

Question 52

Majority of drugs that inhibit protein synthesis target what robosomal subunit: Majority are Cidal or static?

Answer 52

50s Static

Question 53

What are the exceotions to the 50S target?

Answer 53

aminoglycosides tetracyclines

Question 54

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

Answer 54

aminoglycosides | Dalfopristin, Quinupristin (Synercid)

Question 55

Why are dalfopristin and quinupristin cidal?

Answer 55

Synergistic effect - two drugs always given together

Question 56

3 macrolides

Answer 56

erythromicin, clarithromycin, azithromycin

Question 57

Which of the macrolides is ONLY oral?

Answer 57

Clarithromycin

Question 58

What is the main spectrum of macrolides?

Answer 58

Mainly G+

Question 59

Macrolides have similar spectrum as: Makes for a great alternate if? As long as:

Answer 59

Penicillins Penicillin allergy Immunocompetent

Question 60

Clarithromycin + Omeprazole (+ ampicillin) is great for treating

Answer 60

H. pylori

Question 61

Macrolides are DOFC for:

Answer 61

Mycoplasmal pneumonia, Chlamydia trachomotis, C. pneumonia, Legionella

Question 62

Mechanims for resistance against macrolides? (2)

Answer 62

Efflux pumps Methylation of drug binding site

Question 63

Macrolides have the most GI intolerance (diarrhea)?

Answer 63

Erythromycin

Question 64

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

Answer 64

inhibits CYP3A4 IF looking for a drug with no drug interactions - do not look at erythromycin or clarithromycin

Question 65

Which macrolide has no drug interactions?

Answer 65

Azithromycin

Question 66

Which macrolide affects QT prolongation the most? Chance for torsades

Answer 66

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

Question 67

Order of macrolides for worst GI intolerance to best?

Answer 67

Erythromycin, Azithromycin, Clarithromycin

Question 68

Name of ketolide?

Answer 68

Telithromycin

Question 69

Why is telithromycin stronger than macrolides?

Answer 69

Bind tightly to two sides on ribosomal RNA

Question 70

What is very concerning about telithromycin?

Answer 70

Hepatotoxic

Question 71

Why do you even look at telithromycin? Is it DOFC?

Answer 71

community acquired pneumonia STILL NOT DRUG OF FIRST CHOICE

Question 72

Clindamycin can be administered how?

Answer 72

parenteral, oral, topical

Question 73

Clindamycin has what kind of spectrum?

Answer 73

Broad

Question 74

What two specific diseases did we discuss relating to clindamycin?

Answer 74

Toxic Shock Syndrome and Osteomyelitis

Question 75

Clindamycin can penetrate what?

Answer 75

bones - makes it good for osteomyelitis

Question 76

Why are protein synthesis inhibitors used for toxic shock syndrome?

Answer 76

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

Question 77

Clindamycin promotes overgrowth of

Answer 77

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

Question 78

C. diff overgrowth results in

Answer 78

Pseudomembranous colitis

Question 79

What do you do if pt has c.diff?

Answer 79

stop clindamycin and prescribe ORAL vancomycin

Question 80

Dalfopristin and Quinupristin make up

Answer 80

Synercid

Question 81

What is unique about Synercid?

Answer 81

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

Question 82

When would you consider using synercid?

Answer 82

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

Question 83

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

Answer 83

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

Question 84

Linezolid is good for gram (__) infections

Answer 84

gram positive infections

Question 85

Linezolid inhibits

Answer 85

monoamine oxidation

Question 86

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

Answer 86

pheochromocytoma SSRIs/antidepressent Can get toxicities from hyperelevating monoamines