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DAST 7 Exam 2 > Reserve & Special Use AB - 10Qs > Flashcards

Reserve & Special Use AB - 10Qs Flashcards

1
Q

Why are they called reserve AB?

A

Becuz of narrow spectrum and/or severe toxicities

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2
Q

List the reserve agents

A 
A. Chloramphenicol
B. Glycopeptides e.g. Vancomycin, Teicoplanin
C. Linezolid (Zyvox)
D. Streptograminss e.g.  Quinopristin+Dalfopristin
E. Cyclic Lipopeptides e.g. Daptomycin
F. Cyclopeptides e.g. Bacitracin
G. Novobiocin
H. Mupirocin
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3
Q

What are the AEs of chloramphenicol?

A

A. Blood dyscrasias

B. Gray syndrome

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4
Q

MOA of chloramphenicol

A

BacterioSTATIC or BacteriCIDAL depending on m.o. and dose (UNIQUE)

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5
Q

Target of chloramphenicol

A

Binds to 50s ribosomal subunit and inh protein synthesis

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6
Q

What other drugs does chloramphenicol’s target overlap with?

A

Macrolides e.g. Erythromycin, Clarithromycin, Azithromycine Lincosamides e.g. Clindamycin, clindamycin phosphate,
Lincomycin

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7
Q

Is the antianabolic effect of chloramphenicol also seen in humans?

A

Yes

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8
Q

Name the m.o. Chloramphenicol is reserved for?

A

Gram tve

Anaerobes

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9
Q

How does resistance dev to chloramphenicol?

A

Stepwise and involves INDUCTION OF AN ENZYME that acetylates the drug

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10
Q

What’s chloramphenicol used primarily for?

A

Typhoid fever (Salmonella typhi)

H. Influenza meningitis

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11
Q

Uses of Chloramphenicol’s pro drugs
A. Hemisuccinate ester

B. palmitate ester

A

A. IV injection

B. oral suspension

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12
Q

MOA of Vancomycin

A

BacteriSTATIC

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13
Q

What’s vancomycin’s target?

A

Binding to acyl D-Ala-D-Ala peptides and so inh bacterial cell wall biosynthesis

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14
Q

Uses of vancomycin

A

Gram tve
Anaerobes
MRSA

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15
Q

Uses of PO vancomycin

A

C. Diff (colitis)

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16
Q

How does resistance dev against vanco?

A

Alteration of cell wall D-ala groups precursors to a lactate precipitate

T/4 vanco can’t recognize target

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17
Q

What’s the unique SE of vancomycin?

A

Red-man/ red-neck syndrome

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18
Q

How’s Teiocoplanin’s (similar to vanco) delivered to the body?

A

IM

As a depot (highly protein bound), t4 dosed once daily

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19
Q

Whats d Relationship btw Teicoplanin and histamine release?

A

Doesn’t cuz significant histamine release ff IV admin

T4, fewer SEs

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20
Q

Is Teicoplanin used over vanco?

A

No.

Becuz of cost. It’s reserved for when vanco is ineffective)

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21
Q

What’s linezolid’s target?

A

Binds to 23s ribosomal subunits of the 50s subunit

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22
Q

MOA of Linezolid.

A

BacteriCIDAL against Streptococci sp

BacterioSTATIC against other gram tve

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23
Q

What’s Linezolid clinically used for?

A

Inf caused by AEROBIC gram tv

24
Q

What’s the recommended use for Linezolid?

A

For VRE - Vanco resistant enterococci
Staph aureus (including MRSA)
Streptococcus sp

25
Q

How’s Linezolid metabolized?

A

By oxidative opening of the morpholine ring

26
Q

Is drug-drug int cuzed by metabolism a concern for Linezolid?

A

No.

P-450 doesn’t metabolize Linezolid, so no d-d int

27
Q

Does Linezolid affect MAO?

A

Yes.

Linezolid is a non-selective inh of MAO

28
Q

What’s the relationship btw Macrolides and streptogramniss?

A

There’s a remote relationship, but little or no cross sensitivity.

29
Q

Name the targets of streptogramniss (Quinopristin + Dalfopristin).

A

50s subunit

30
Q

What’s the primary use of streptogramniss (Quinopristin + Dalfopristin)?

A

For VRE faecium, NOT VRE faecalis

31
Q

What are the special cases that streptogramniss (Quinopristin + Dalfopristin) is used for?

A

Gram tve org e.g. S. aureus and Streptococci sp

32
Q

Any significant metabolism for streptogramniss (Quinopristin + Dalfopristin)?

A

Potent inh of P-450 3A4

T4 d-d int is possible

33
Q

What’s the target of Daptomycin?

A

Bacterial membranes causing rapid depolarization

34
Q

What’s Daptomycin indicated for?

A

SSSI caused by a variety of gram tve org e.g.
E. faecalis
Staph aureus including MRSA

35
Q

What parameter should be monitored if a pt is on Daptomycin?

A

CPK

Elevation of CPK has been reported => muscle pain/ weakness

36
Q

What enhances the activity of Bacitracin?

A

Zn ion

37
Q

How should bacitracin be stored?

A

Refrigerated and should not be kept for more than 1 week

38
Q

MOA of bacitracin

A

BacteriSTATIC/CIDAL depending on m.o. and conc.

39
Q

What’s the target of bacitracin?

A

Interferes with late stage cell wall formation and cell membrane

40
Q

What’s bacitracin occasionally used to treat?

A

PMC

41
Q

Following what route of admin is bacitracin well absorbed?

A

IM

42
Q

Bacitracin is widely distributed into the tissues except in

A

CNS

43
Q

MOA of Polymixin B sulfate

A

BacteriCIDAL after binding to phospholipids of CYTOPLASMIC MEMBRANE.

44
Q

SEs of bacitracin

A

Severe nephro- & neurotoxicity

45
Q

What’s the MOA of Novobiocin?

A

BacterioSTATIC by inh DNA gyrase

46
Q

What’s Novobiocin reserved for?

A

For resistant gram tve m.o. - Staph aureus, Proteus vulgaris

47
Q

What’s the effect of rapid hydrolysis in vivo in Mupirocin?

A

Used Topically only for Staph and Strept. skin inf

48
Q

What’s Mupirocin’s target?

A

Binds to bacterial enzyme isoleucyl transfer-RNA synthase preventing the incorporation of isoleucine into bacterial proteins

49
Q

Which AB is cidal against Strep and static against other gram tv m,o.?

A

Linezolid

50
Q

Which AB causes an increase in CPK, therefore, muscle pain/weakness may be an issue?

A

Daptomycin

51
Q

Which AB does Zn ion. Enhances its activity?

A

Bacitran

52
Q

Which atypical / reserve AB are both bacteriSTATIC and CIDAL?

A

Chloramphenicol
Linezolid
Bacitracin

53
Q

Which reserve AB are active against VRE?

A

Linezolid

Quinopristin+Dalfopristin [VRE faecium only]

54
Q

What reserve AB are inh of P-450?

A

Quinopristin+Dalfopristin

55
Q

Which atypical AB are effective against gram tve Anaerobes?

A

Chloramphenicol

Vancomycin

56
Q

Which atypical AB is effective against gram tve Aerobes?

A

Linezolid

57
Q

Which reserve AB attacks bacterial membrane?

A

Daptomycin

Bacitracin

DAST 7 Exam 2 (9 decks)

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