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Unit 2- Pharm > Red/Bolded Words/Review - Deck 3 > Flashcards

Red/Bolded Words/Review - Deck 3 Flashcards

1
Q

Describe general characteristics of aminoglycosides

how do they get into cell?

only effective against what kind of bacteria?

A

polar

need active transport (requires O2)

gram (-) aerobes due to process above

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2
Q

Aminoglycosides have broad or narrow spectrum

A

narrow

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3
Q

Aminoglycosides are typically given when you have what kind of infection

A

serious

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4
Q

Aminoglycosides are usually administered how?

A

parenterally - again, typically with very serious diseases

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5
Q

Why do you typically give aminoglycosides in combination?

A

empirical therapy, serious infection, broad spectrum

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6
Q

Aminoglycosides are cidal/static?

A

cidal

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7
Q

What type of drugs are aminoglycosides administered with

A

Inhibitors of cell wall synthesis

2 cidal drugs - one inhibits cell wall synthesis and the other inhibits protein synthesis

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8
Q

Aminoglycosides: DOFC

A

pseudomonas

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9
Q

Aminoglycosides active against Gram (___) and anaerobes or aerobes

Administered how?

A

Gram - aerobes

Parenteral

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10
Q

Aminoglycosides are active against what pathogens?

A

enterococcus

tularemia

pseudomonas

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11
Q

Aminoglycosides toxicities (2)

A

Ototoxicity

Nephrotoxicity

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12
Q

Nephrotoxicity and ototoxicity are what kind of side effects?

A

Concentration and time dependent

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13
Q

Aminoglycosides concentrate where?

A

inner ear - hence the ototoxicity

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14
Q

Aminoglycosides are best given in what kind of doses?

Why?

A

Mega

Because the mega dose results in less time over the concentration threshold

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15
Q

Aminoglycosides have significant

A

post-antibiotic effect

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16
Q

What does post-antibiotic effect mean?

A

When concentration dips below threshold, we still have suppression of bacterial growth.

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17
Q

How does post-antibiotic effect affect the time between doses?

What effect does PAE have on adverse side effects?

A

increases the time between doses

reduces chance of adverse side effects (concentration dependent)

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18
Q

With enterococci, how do aminoglycosides and penicillins work together to produce synergism?

A

No.

Use penicillin to open up cell wall and then aminoglycosides do not need O2 to get through and the two together produce synergistic effect.

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19
Q

Chloramphenicol: what kind of spectrum

A

broad

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20
Q

Chloramphenicol toxicity level

A

HIGH

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21
Q

When would you use chloamphenicol?

A

with life-threatening disease due to broad spectrum and high toxicity levels

Benefit must outweigh risk (pt will be killed)

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22
Q

Chloamphenicol binds to what subunit?

Cidal/static?

A

50S

Static

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23
Q

Chloramphenicol’s claim to fame?

A

100% CNS bioavailability without inflammation

THE BEST DRUG WE HAVE FOR CNS INFECTIONS

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24
Q

Chloramphenicol can be used for ______ instead of penicillin if there is a penicillin allergy

A

meningitis

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25
Q

Chloramphenicol is a DOFC for

A

Rocky Mountain Spotted Fever (life-threatening)

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26
Q

Chloramphenicol: for elimination, drug must be:

A

conjugated to glucuronic acid

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27
Q

Chloramphenicol cannot be used in what populations?

Why?

A

Neonates

Naive livers - cannot make glucuronyl transferase, so cannot conjugate and eliminate.

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28
Q

If you give chloramphenicol to a neonate what happens?

A

Gray Baby Syndrome

Life-threatening

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29
Q

Chloramphenicol toxicities:

Dose-dependent:

Dose-independent

A

D-D: bone marrow suppression - reversible upon discontinuation of drug

D-I: fatal aplastic anemia - can be from single dose OR can occur months after drug has been discontonied

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30
Q

Tetracyclines bind to what subunit

A

30S

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31
Q

Tetracyclines: cidal/static

A

Static

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32
Q

Tetracyclines are broad/narrow spectrum

A

BROAD: Gram+/- anaerobes and aerobes

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33
Q

3 organisms resistant to tetracyclines

A

B. fragilis

Proteus

Pseudomonas

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34
Q

Which GI bacterial infection can tetracyclines be used against in combination with metronodazol and bismuth?

A

H. Pylori

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35
Q

DOC for what intestinal bacterial infection?

A

Cholera

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36
Q

What three drugs can be used against Lyme Disease?

A

doxycycline

ceftriaxone

ampicillin

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37
Q

What can be used in rocky mountain spotted fever?

A

doxycycline

38
Q

For tetracycline (ONLY), what is main mode of resistance?

A

efflux pumps

doxy and mino are not good substrates for those pumps, so they can still be used

39
Q

Tetracycline (doxy and mino are better than tetra) should not be taken when vitamins why?

A

Because they chelate with Al, Ca, Fe

40
Q

Tetracyclines deposit where?

A

bone and teeth

41
Q

Tetracyclines contraindications?

A

pregnant women and children under age of 8

42
Q

What is the major adverse reaction associated with tetracyclines?

A

photosensitivity

43
Q

Tigecycline is a good alternative for what?

A

tetracycline-resistant organisms

44
Q

Tigecycline binds to what subunit?

Static/cidal

A

30S

Static

45
Q

All of the floxacins are under what class of drugs?

A

fluoroquinolones

46
Q

How do fluoroqiunolones work?

A

inhibit DNA gyrase which prevents relaxation of positively supercoiled DNA that is required for transcription and replication

47
Q

Fluroquinolones: cidal/static?

A

cidal

48
Q

Ciprpofloxacin is used for what kind of infections:

A

UTI

49
Q

Ciprofloxacin has/does not have antipseudomonal activity?

A

Does have antipseudomonal activity

50
Q

Ofloxacin is used for what?

Why?

A

Prostatitis - penetrates dense prostate gland

51
Q

Levofloxacin used mainly for?

A

community acquired pneumonia

52
Q

Moxifloxacin and Gemifloxacin are the ONLY two fluroquinolones that work on what kind of organisms:

A

ANAEROBIC

53
Q

Gatifloxacin is used for?

A

ocular application only

54
Q

How are fluoroquinolones administered?

A

orally

55
Q

What should you warn your patient about when taking fluroquinolones with other medications?

A

Do not take iron, magnesium, aluminum, calcium

56
Q

Fluoroquinolones can be given with _____ to:

A

probenecid to increase retention so it is not excreted as quickly and increase the therapeutic effect

57
Q

What makes fluoroquinolines contraindicated in pregnant women and in children under age of 18

A

Cartilage erosions

58
Q

4 main adverse effects of fluoroquinolines

A

increase QT interval

cartilage erosions

tendon rupture

photosensitivity

59
Q

Metronidazole is only active against anaerobes/aerobes?

A

anaerobes

60
Q

Metronidazole: Mechanism of Action

A

prodrug

non-enzymatically reduced by reacting with reduced ferredoxin (only found in anaerobes)

Prodrug b/c metronidazole metabolites are taken up into bacterial DNA and form unstable molecules

61
Q

Metronidazole: static or cidal

Gram (___)

A

Cidal

Positive and negative (ANAEROBES)

62
Q

Metronidazole is an OPTION for which two intra-abdominal infections

A

C. Diff (alternate to vanco) and H. pylori (multi-drug regimen)

63
Q

2 main adverse effects of metronidazole?

A

Disulfram-like reaction

Digeusia - metallic taste

64
Q

What are the two EXCLUSIVE UTI drugs?

A

Nitrofurantoin

Methenamine

65
Q

What makes Nitrofurantoin and Methenamine exclusively UTI drugs?

A
  1. renal excretion
  2. must achieve high urinary concentrations to become effective - only place they concentrate
  3. require acidic pH to be active
66
Q

What is nitrofurantoin mechanism of action?

A

damages bacterial DNA

is a prodrug

67
Q

Nitrofurantoin spectrum

A

BROAD - EXCEPT PROTEUS (makes urine more basic) AND PSEUDOMONAS

68
Q

Nitrofurantoin: adverse effect if patient has Glucose-6-Phosphate Deficiency

A

hemolytic anemia

69
Q

Contraindication of nitrofurantoin

A

late-term pregnancy because we do not know if child has G-6-P-D deficiency

70
Q

Other adverse side effect of nitrofurantoin - especially in elderly

A

pulmonary fibrosis

71
Q

Methanamine is decomposed to:

A

formaldehyde and ammonia in the acidic medium of UT

72
Q

When would you NOT use methanamine?

It will result in:

A

if your patient has hepatic or renal insufficiency and cannot handle the byproduct of ammonia

hepatic encephalopathy

73
Q

Main sulfonamide

A

Sulfamethoxazole + trimethoprim = BACTRIM

74
Q

How is Bactrim administered?

A

Orally and parenterally

75
Q

What is a good example of synergism with sulfonamides?

A

sulfamethoxazole and trimethoprim

76
Q

Sulfamethoxazole MOA:

Trimethoprim MOA:

Remember - these work together! Synergism.

A

Sulfa - competes with PABA in syn of bacterial folic acid

Tri - prevent reduction of dihydrofolate to tetrahydrofolate which is essential for one carbon transfer

77
Q

3 resistance mechanisms of sulfamethoxazole + trimethoprim

A

efflux pumps

increased prodcution of essential metabolite - PABA

Alternative metabolic pathway for synthesis of essential metabolites (plasmid)

78
Q

Bactrim: static or cidal

A

static BUT in urinary tract, it is CIDAL if high concentrations are obtained

79
Q

Bactrim is DOFC for:

A

UTI (first attack)

80
Q

Sulfa drugs inhibit Gram (__) drugs

A

+ and -

81
Q

4 Adverse Effects of Sulfa Drugs

A

aplastic anemia

photosensitivity

hypersensitivity

SJS

82
Q

What class has second highest drug sensitivity after penicillins

A

Sulfas

83
Q

What is Kernicterus and what class of drugs is it associated with?

Should not give these drugs to children under

A

binding of bilirubin to plasma proteins

sulfas

2 months of age

84
Q

Daptomycin MOA

static/cidal

A

binds to bacterial membrane and cause rapid depolarization of membrane potential

cidal

85
Q

Daptomycin is good against gram (__)

aerobes/anaerobes

A

positive

both

86
Q

How does muciprocin work?

A

bacterial protein and RNA synthesis are inhibited when mupirocin binds to bacterial t-RNA synthetase

87
Q

Mupirocin is adminstered

A

topically

88
Q

Mupirocin: static or cidal

A

static at low, cidal at high concentrations

89
Q

Besides skin, where is mupirocin applied?

A

intranasally

90
Q

Polypeptide antibiotics used against gram (_) infections

A

gram -

91
Q

Polypeptide MOA

A

binds to G- bacterial cell membrane phospholipids which increases permeability of cell membrane and loss of metabolites essential to bacterial existence

92
Q

Polymyxin is used in combination with:

A

neomycin and bacitracin

Unit 2- Pharm (9 decks)

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