pharma II test IV antimicrobials

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pharma II test IV antimicrobials
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2013-05-03 00:37:47
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pharma II test IV antimicrobials
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  1. 3 bacteria that don't have a cell wall
    • M. pneumonia
    • chlamydia
    • rickettsia
  2. TMP/SMS prophylaxis for what
    pneumocystis jirovecii in a pt on cyclosporine and prednisone after liver transplant
  3. azithromycin prophylaxis for what
    mycobacterium avium intracellulare in an advanced HIV pt
  4. cefazolin prophylactically for what
    before surgery to prevent staphylococcal skin infecton at surgical site
  5. protein synthesis inhibitor that is bacteriocidal rather than bacteriostatic
    aminoglycosides
  6. 4 antifungal groups
    • polyenes
    • azoles
    • pyrimidines
    • topical agents
  7. 2 examples of time-dependent bacterial killing
    • vancomycin
    • b-lactams
  8. 2 examples of concentration-dependent killing
    • aminoglycosides
    • fluoroquinolones
  9. 5 general bacterial resistance mechanism
    • intrinsic resistance
    • mutations
    • plasmids
    • loss of porins
    • efflux pumps
  10. what is the cell wall alteration that develops bacterial resistance to vancomycin
    D-alanine D-alanine to D-alanine D-lactate
  11. 5 antimicrobial classifications
    • inhibitors of folate metabolism
    • cell-wall synthesis inhibitors
    • inhibitor of protein synthesis
    • inhibition of DNA synthesis
    • miscellaneous
  12. moa - inhibits the synthesis of folic acid by bacteria from para-amino benzoic acid
    sulfonamide
  13. which sulfonamide is not rapidly absorbed for GIT - found in urine withing 30 minutes
    causes red body fluids
    sulfasalazine
  14. drug interaction of sulfonamides  with displacement from albumin
    • warfarin
    • kernicterus in neonates - displacement of bilirubin from its binding site causing encephalopathy
  15. murein monomer synthesis
    inhibits bacterial phospho enol pyruvated transferase
    excreted unchanged in the urine
    well tolerated (use in prego)
    precipitates with antacids
    fosfomycin - monurol
  16. murein monomer synthesis inhibitor
    structural ananlog of D-ala
    inhibits hepatic metabolism of phenytoin
    second line agnet to treat multidrug resistant M. tuberculosis
    cycloserine - seromycin
  17. moa - inhibits cell wall synthesis by binding to D-Ala D-Ala, inhibiting transglycosidase
    glycopeptide
    bactericidal against gram positive rods
    AE - red-man syndrome
          skin flushing
          nephrotoxicity
          ototoxicity
    vancomycin - vancocin
  18. inhibitor of murein polymer synthesis
    glycopeptide
    T 1/2 45-70 hr
    prolongs QT interval
    reserved for prophylaxis and Tx of MRSA
    teicoplanin - targocid
  19. 4 beta-lactam antibiotics
    • penicillins
    • cephalosporins
    • monobactams (aztreonam)
    • carbapenems
  20. reaction of penicillin toxicity
    maculopapulary rash
  21. 4 penicillin classes
    • natural
    • b-lactamase resistnat (anti-staph)
    • aminopenicillins
    • anti-pseudomonal
  22. natural penicillins
    • pen G
    • pen VK
  23. b-lactamase resistant penicillins
    • methicillin
    • nafcillin
    • oxacillin
    • cloxacillin
    • dicloxacillin
  24. aminopenicillins
    • ampicillin
    • amoxicillin
    • bacampicillin
  25. anti-pseudomonal penicillins
    • piperacillin
    • ticarcillin
    • carbenicillin
  26. drug of choice for syphilis
    pen G
  27. which aminopenicillin is better bioavailable, better tolerated and has a longer half life
    amoxicillin
  28. penicillins that are acid labile
    • pen G
    • anti-pseudomonal penicillins
  29. penicillins tha are acid-stable
    • pen VK
    • antistaphylococcal (b-lactamase-resistant)
    • aminopenicillins
  30. amoxicilline + clavulanic acid
    augmentin
  31. ticarcillin + clavulanic acid
    timentin
  32. ampicillin + sulbactam
    unasyn
  33. piperacillin + tazobactam
    zosyn
  34. 2 time dependent antibiotics
    • beta lactams
    • macrolides
  35. semisynthetic derivatives from a fungus
    bactericidal action
    broad spectrum
    not effective against enerococci, listeria, or MRSA
    cephalosporins
  36. pregrogression of cephalosporins through the generations
    • increasing activity against gram (-) bacteria, anaerobes, MRSA
    • increase resistance to destruction by beta-lactamse
    • increased resistance to destruction by beta-lactamase
  37. subclass of 3rd gen cephalosporins
    cefamandole, cefmetazole, cefotetan
    2 adverse reactions
    • inhibits vitamin K produciton and prolongs bleeding
    • causes disulfuram-like reaction when co-administered with ethanol
  38. subclass of thrid gen cephalosporins
    ceftriaxone
    2 adverse reactions
    • interacts with calcium-containing medications to form crystals that precipitate in liver and kidney leading to fatalities
    • causes biliary sludging and hyperbilirubinemia
  39. b-lactam group
    IV form only
    good CNS penetration
    broades spectrum
    moa- cell wall inhibitors
    carbapenems
  40. carbapenem
    cause seizures
    reduce dose in renal dysfunction
    imipenem
  41. carbapenem
    not effective against pseudomonas
    ertapenam
  42. carbapenem
    inactivated by dehydropeptidase I in renal tubules
    metabolites are nephrotoxic
    and what do you add to combat the inactivation
    • imipenem
    • cilastatin making primaxin
  43. carbapenem
    longer half life
    once daily dosing
    ertapenem
  44. monobactam
    IV or IM
    ind - binds to PBP or gram (-) aerobes
    not active against gram (+) or anaerobes
    aztreonam - azactam
  45. only inhalation antibiotic
    ind - P. aeruginosa in cystic fibrosis
    cayston (aztreonam)
  46. ind - MRSA & VRE
    cyclic lipopeptide
    moa - binds to cell membrane of gram (+) allowing ions causing rapid depolarization of membrane
    AE - myopathy
    inactivated by surfactant in the lungs, can't be used to treat pneumonia
    daptomycin - cubicin
  47. antibacterial agent group
    derived from actinomycete/semisynthetic
    poor oral absorption
      polar compounds, poor lipid solubility
      no PO forms for systemic infection
      PO forms are for GI infection only
    aminoglycosides
  48. antibacterial
    most effective against gram (-)
    sugars = poor GI absorption
    binds to the 30S subunit
    bactericidal
    excreted unchanged in the urine
    ineffective against anaerobic bacteria
    aminoglycosides
  49. aminoglycoside 5
    IM or IV
    for systemic
    sulfate salts
    • gentamicin
    • tobramicin
    • amikacin
    • kanamycin
    • streptomycin
  50. aminoglycoside
    sulfate salt
    oral
    ind - GI infections
    • kanamycin
    • neomycin
    • paromomycin
  51. aminoglycoside that is the least susceptible to resistance
    amikacin
  52. 3 moa of aminoglycosides
    • block of initiation of complex
    • miscodes peptide chain
    • block translocation
  53. aminoglycoside
    ind - mycobacteria
    streptomycin
  54. 3 toxicities of aminoglycosides
    • ototxicity
    • nephrotoxicity
    • NMJ blockade CI - myasthenia gravis
  55. what drug group would compound a toxicity of aminoglycoside
    loop diuretic- nephrotoxicity
  56. long acting tetracycline
    nonrenal clearance
    phototoxicity
    doxycycline
  57. antimicrobial
    bacteriostatic
    inhibits 30S ribosome
    broad spectrum
    DOC for rickettsia
    not damaging to humans because of efflux pumps
    tetracycline
  58. complexes with divalent ions
    watch for superinfections
    can cause fanconi syndrome
    tetracycline
  59. complexes with trivalent ions
    • doxycycline
    • minocycline
  60. inhibits 30S subunit
    increased mortality
    broad spectrum
    active against MRSA and VRE
    tigercycline - tagacil
  61. bacteriostatic
    inhibits 50S subunit
    metabolized by hepatic glucuronyl transferase
    broad spectrum
    eyedrops for bacterial conjunctivitis
    AE - gray baby syndrome
           aplastic anemia
    chloramphenicol
  62. 5 macrolides
    • erythromycin
    • azithromycin
    • clarithromycin
    • telithromycin
    • fidaxomicin
  63. macrolide
    oral and parenteral
    acid labile
    take on an empty stomach
    stearate, estolate, & ethylsuccinate to increase T 1/2
    erythromycin
  64. macrolide
    inhibits CYP 450
    excreted via bile = colistatic jaundice
    ind - upper respiratory tract infections
    prophylaxis of endocarditis
    AE - cardiotoxic
    erythromycin
  65. macorlide
    more potent than erythromycin
    not children < 6
    used in combo with PPI for H. pylori
    clarithromycin - biaxin
  66. macrolide
    more effective than erythromycin against gram (-)
    moa - penetrates into most tissues except CSF
    not to be taken with food or antacid
    does not inhibit CYP 450
    azithromycin
  67. which macorlide does not inhibit CYO 450
    azithromycin
  68. 2 lincosamides
    • lincomycin
    • clindamycin
  69. lincosamide
    used for infections in oral cavity
    lincomycin
  70. lincosamide
    prophylaxis against endocarditis
    causes pseudomembranous enterocolitis
    clindamycin
  71. Tx of pseudomembranous enterocolitis caused by clindamycin
    • drink a lot of water and pee out
    • metronidiazole then vancomycin if needed
  72. strepogramin
    moa - inhibits 50S
    effective against MRSA & VRE
    AE - myalgia
           arthralgia
           thrombophlebitis
    quinupristin + dalfopristin - synercid
  73. oxazolidinone
    gram (+) activity
    only oral drug available for MRSA & VRE
    moa - inhibits 50S subunit
    linezolid - zyox
  74. 3 fluoroquinolones
    • ciproflxacin
    • levofloxacin
    • moxifloxicin
  75. antimicrobial agent group
    bactericidal
    broad spectrum
    resistance develops quickly
    moa - inhibits DNA gyrase
             inhibits topoisomerase IV
    absorption reduced by antacids,dairy products and iron
    fluoroquinolones
  76. antimicrobial
    AE - phototoxicity
    QT prolongation
    CI - < 18 yo (arthropathy)
          pregnancy, nursing
    drug interaction with warfarin
    fluoroquinolones
  77. fluoroquinolone
    only one used against anaerobes
    less renal clearance, not used in UTI
    moxifloxacin
  78. effective against gram (-) and protozoa
    not aerobes
    not used as monotherapy except C. diff
    active agianst trichomoniasis - treat sexual partner as well
    moa - free radical mediated cell death
    metronidazole - flagyl
  79. primary alternate to TMP/SMX to treat pneumocystotic carinii pneumonia
    HIV infected pts
    IV or inhalation
    pentamidine isethionate - pentamm
  80. topical use for impetigo
    mupirocin - bactroban
  81. 3 antiseptic and analgesic agents for UTI
    • methenamine
    • nitrofurantoin
    • phenazopyridine
  82. prodrug that generates formaldehyde HCHO in acidic urinary pH
    methenamine mandelate
  83. synthetic nitrofuran
    microcrystalline form
      slow absorption/exrection
      less GI irritation
    colors urine brown
    nitrofurantoin - furadnatin
  84. Not a urinary antiseptic
    has analgesic action on the urinary tract
    colors urine orange or red
    AE - GI upset
           methemoglobinemia
    phenazopyridine - pyridium

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