Tetracyclies/aminoglycosides/Macrolides

Question 1

Tetracycline General

Answer 1

Binds 30S subunit of bacterial ribosome

Broad spectrum Bacteriostatic for Gram + and Gram -

AE: GI disturbance (Nausea, vomiting, diarrhea), Discoloration and enamel dysplasia of teeth, Liver toxicity, photosensitivity, Vestibular problems, pseudotumor cerebri, superinfections (gut flora + Candida), Fznconi syndrome

Contra: Renally impaired, Pregnant, Children <8

Question 2

Doxycycline

Answer 2

• • DOC for Typhus, RMSFever, nonspecific urethritis (Ureoplasma), atypical pneumonia (Myco. Pneum), Lyme disease, granuloma inguinal (Klebsiella)
• Also used for Chlamydia infection, Leptospirosis syphilis, and Plamodium falciparum
• Used w/ AG for tularemia + Plague

Question 3

Minocyclins

Answer 3

Meningococcal Carrier State

Acne

Question 4

Tetracycline

Answer 4

Ulcer Diseases (Helicobacter Pylori)
Acne

Question 5

Tigecyclins

Answer 5

• Circumvents resistance
• MRSA, MRSE, VISA, VRSA, PRSP, and VRE
• Complicated infections of skin and abdomen

Question 6

What are the main pharmacokinetic concerns with tetracyclines?

Answer 6

Impaired by dairy producers, act acids, and Fe preps

Question 7

Where do tetracyclines distribute to the most?

Answer 7

Bones + Teeth

Question 8

Which Tetracyclines are NOT reabsorbed in the intestine?

Answer 8

Doxycycline

Tigecycline

Question 9

Aminiglycosides General

Answer 9

Target bacterial ribosome 30S in aerobic Gram - Bacilli
Not absorbed P.O.
-Mycin

AE: Ototoxicity, Nephrotoxicity

Question 10

Streptomycin

Answer 10

• DOC for Plauge (Yers. Pest is) + Tularemia (Franc. Tul.)

- Also indicated for Brucella, TB, Bacterial endocarditis

Question 11

Gentamicin/Tobramycin

Answer 11

• Gram - Aerobes
• SEVER infections: Bacteremia, Endocarditis, meningitis, pneumonia, Gram - UTIs
• Bugs: PEcK, Enterobacter, Pseudomonas, Serratia, MRSA, MRSE,
  Gentamicin: Strep Vir./Agal., Listeria, and Campylobacter
  Tobramycin: Pseudomonas

Question 12

Amikacin

Answer 12

• Broadest Spectrum AG
• Bugs: Nosocomial Enterobacter, Serratia, PEcK, Pseudomonas
• ALS treat Serious aerobic gram - infections (endocarditis, bacteremia, etc)

*** INC resistance to inactivation

Question 13

Neomycin

Answer 13

• Topical or Oral

- Skin infection, bowel sterilization, and hepatic coma

Question 14

Macrolides General

Answer 14

• Bacteriostatic which Inhibit 50S ribosomal unit
  “-thromycin”
• AE: GI disturbance, Ototoxicity, Cardiotoxicity; Eryth/Clarith inhibit CYP450
• Contra: Hepatic dysfunction; Renal dysfunction;

Question 15

Erythromycin

Answer 15

• Gram + Like Strep, Listeria, Anthrax, Diptheria, Chancroid, RTIs(Legionella, Mycoplasma, Moraxella), Campylobacter, Ureaplasma
• Back up for: Klebsiella, Chlamydia

Question 16

Clarithromycin

Answer 16

• Similar to erythromycin
• INC activity for Haem inf, Strep, Staph, Myco. Avium, chlamydia, legionella, ureaplasma, Leprosi, + Heli. Py.
• FIRST LINE: Mycobacterium avium; Chamydia Pneumoniae, + Corynebacterium Diphtheriae

Question 17

Azithromycin

Answer 17

• Similar to Clarithromycin
• MORE against: Haem. Infl, Moraxella
• DOC: Certain Chlamydia (Trachoma + Nonspecific urethritis)
• First Line: Legionella, Diphtheria, Chancroid, Myco Avium
• Other: Myco. Pneum, HAem, Moraxella, Klebsiella, Ureeaplasma, Lyme Disease

Question 18

Macrolide resistance Mechs

Answer 18

1. Modification of ribosomal binding site
2. Production of plasmid-associated esterase
3. Reduced permeability of cell membrane or active efflux

Question 19

Ketolide (Telithromycine)

Answer 19

Binds 2 specific sites on ribosome (23S rRNA)

Telithromycine
- Community asquired Pneum including Staph A., Strep Pyo., MDRSP, Haem, Mora, Legion, Myco, Chlamyd Pneum

AE: GI Upset, Headache/Dizziness, Jaundice, Hepatic failure

Contra: Children <18