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136 Cards in this Set
- Front
- Back
How is gram - bacteria different from gram +?
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Gram - has 2 membranes with a thinner peptidoglycan layer (harder to treat than gram +)
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What are the 3 most important things to know when perscribing antibiotics?
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Know the patient
Know the microbiology Know the drugs |
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What is the definition of an ANTIMICROBIAL?
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Antibacterial, antiviral and antifungals
Natural or SYNTHETIC compounds that kill or suppress growth of microorganisms |
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What is the definition of ANTIBIOTIC
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NATURAL compounds made by microorganisms that have the ability to harm another microorganism
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Name 3 types of AntiBIOTIC therapy?
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1. Empiric: presumptive ( not sure of the microorganism)
2. Documented: know the culture and treating it 3. Prophylaxis: prevent the infection |
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Describe Bacteriocidal activity
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Bacteriocial drugs kill organisms so that the # of viable organisms decrease rapidly
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Describe BacterioSTATIC activity
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BacterioStatic drugs inhibit the gorwth of bacteria but do not kill them.
Encourage the body to the do the killing |
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What are narrow spectrum antimicrobials?
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Active against a single species or limited group of pathogens
Used for DOCUMENTED therapy |
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What are broad spectrum drugs?
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Active against wide range of pathogens
often for empiric therapy |
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Describe the Minimal inhibitory concentration (MIC)
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Lowest concetration of drug that prevents visible vacterial growth after 24 hours of inculbation in a specified growth medium
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How does the lab report drug cultures?
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1. Susceptible
2. Intermediate 3. Resistant |
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What are the 2 bugs have resistance over drugs?
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1. Intrinsic: lack of activity before antibiotic exposure
2. Acquired: develops during therapy through mutations or transformations |
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Does the dose matter for Concentraiton-dependent antibiotics? Give some exs
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Yes, the concentration must stay above the MIC
ex. Aminoglycosides, Quinolones, Datomycin |
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What the amount of antibiotic in the system matter for time-dependent antiobiotics? Give some examples
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No, just the time it stays above the MIC, not the level above the MIC
Ex. Penicillins, Cephalosporins |
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What are the 5 classes of Antimicrobials?
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1. Cell Wall Synthesis Inhibitors
2. Protein Synthesis Inhibitors 3. Alter nucleic acid metabolism 4. folate metabolism inhibitors 5. Miscellaneous mechanisms |
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What classes of drugs are cell wall synthesis inhibitors?
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1. Beta Lactams
2. Glycopeptides |
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What classes of drugs are Beta Lactams?
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1. Penecillins
2. Cephalosporins 3. Monobactam (azetreonam) 4. Carbapenems |
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What is the MOA of B-Lactams? Time or concentration dependent? Bacteriostatic or cidal?
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Interfere with the last step of bacterial cell wasll synthesis
-Time dependent killing -bactericidal |
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What areas is penecillin not optimal for treating?
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1. Eye
2. brain 3. CSF 4.prostate in the absence of inflammation |
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What type of penecillins are hepatically metabilized and excreted in the bile?
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Semi-sythetic penecillins
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What is the pregnancy category for B-Lactam antibiotics?
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Category B
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What are the adverse effects of Penecillins?>
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1. Anaphylaxis
2. Diarrhea 3. Interstital nephritis 4. CNS effects: seizures 5. increased liver enzymes |
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What is the spectrum of activity for Natural Penecillins?
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Narrow Spectrum
-Select gram +, select gram -, few anaerobes, spirochetes |
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What is the drug of choice for syphilis?
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Penecillin G
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Which Natural Penecillin can be given PO
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Penecillin V
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What is the spectrum of activity for penecillin-resistant penecillins?
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Narrow!
GRAM POSITIVE ONLY -used to treat MSSA, not MSRA |
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Describe the spectrum of activity for Aminopenecillins
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Narrow
considered extended spectrum but still narrow -similar to PCN G but more GRAM +s ad -s |
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What is the spectrum for pseudomonal Penicillins?
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Broad Spectrum
-increased activity against gram -'s ONLY ONES THAT CAN BE USED FOR PSEUDOMONALS! Ex. Piperacillin (zosin) |
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What is the spectrum for B-Lactamase Inhibitors?
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Broad Spectrum
-depends on the parent B-lactam -Gram +, gram -, anareobic orgs |
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What is the spectrum trend for 1st - 4th generation Cephalosporins?
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First Generation is more gram + and narrow spectrum
-4th spectrum is more gram - and broad |
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What is the spectrum exception for 1st generation cephalosporins?
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Cefazolin is the only broad spectrum 1st gen
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What generation of cephalosporins can enter the CNS?
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1st generation ONLY
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What generations of cephalosporins are used to treat meningitis?
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3rd and 4th
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What is the primary excretion for cephalosporins? Are there any exceptions?
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Primary: urine
Exceptions: Ceftriaxone and cefoprazone (biliary excretion) |
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What are some adverse effects of Cephalosporins?
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1. Anaphylaxis, rash
2. IM pain at injection 3. Diarrhea 4. Intestinal nephritis 5. CNS (seizures) 6. Biliary sludge |
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What caution should you take with cephalosporins?
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If pt has severe allergic rxn. Anaphylaxis (avoid giving to pts with Severe PCN rxn)
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What is the spectrum of Monobactam (Azetreonam)?
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Relatively Narrow
-ONLY GRAM - -Has some pseudomonas coverage |
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Can pts with severe PCN rxns be given Monobactam?
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Yes!
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Can monobactam be given orally?
What are its adverse effects? |
No, only IV or IM because of no GI absorption
-adverse effect: rash |
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Which B-Lactam has the broadest spectrum of activity?
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Carbapenems
-Gram +, gram -, anaerobes |
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What are the clinical uses for Carbapenems?
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1. Reserved for severe, Life threatening, antibiotic resistant infections
2. Only ones for POLYMICROBIAL INFECTIONS!! |
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What Carbapenem is the exception to the broad spectrum trend of the class?
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Ertapenem: it has a narrow spectrum
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Which Carbapenem comes as a combination drug?
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Imipenem-cilastatin
-Cilastatin has no activity on its own |
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Which carbapenem is the only category C drug?
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Imipenem
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What are the adverse effects of Carbapenems?
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1.Anaphylaxis, rash
2. Diarrhea 3. Seizures |
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What type of antibiotic is Vancomycin?
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Glycopeptide
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What is the MOA of Vancomycin?
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Inhibits cell wall synthesis by inhibiting the second state of peptidoglycan synthesis (elongation)
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What is the Spectrum of Vancomycin
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GRAM + ONLY
-Includes MRSA -Considered a broad spectrum antibiotic |
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What is the drug of choice for MRSA?
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Vancomycin
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What is the drug to treat C. Diff?
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Vancomycin PO only
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What is Vancomycin's pregnancy category?
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C
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Can you used PO vancomycin for systemic infections?
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No
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Is Vancomycin bacteriocidal or static? Time or concentration dependent?
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1. BacterioCIDAL
2. Time-dependent Killing! |
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What are the adverse effects of Vancomycin?
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1. Red Man Syndrome
2. Nephrotoxicity 3. Ototoxicity 4. Rash (aside from the RMS symptoms) |
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What causes Red Man Syndrome?
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Pushing vancomycin too quickly in IV
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What antibiotics inhibit protein synthesis (8)?
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1. Chloramphenicol
2. Tetracyclines 3. Glycyclines (tigecycline) 4.Macrolides 5. Clindamycin 6. Stretogramins 7. Oxazolidinone 8. Aminoglycosides |
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What is the Spectrum of Chloramphenicol?
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Gram +, Gram -, and Anaerobic bacteria
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What is the MOA for Chloramphenicol?
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Binds to the 50S subunit
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Is chloramphenicol bacteriostatic or cidal? What is its pregnancy category?
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Bacteriostatic
Pregnancy C |
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What are the side effects of Chloramphenicol?
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1. Hypersensitivity
2. REVERSIBLE BONE MARROW SUPPRESION 3. Rare, potentially fatal aplastic anemia ( can occur during or weeks or months after therapy is over) 4. Gray Baby Syndrome |
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Can Chloramphenicol be given to babies? Why or why not?
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NO!
-causes Gray Baby Syndrome: abdominal distention, vomiting, cyanosis, circulatory collapse and death |
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What is Tetryclycine's spectrum?
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Narrow
-Used for tick bourne illnesses -Acne -option for pts allergic to PCN |
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What is the MOA of tetracyclines?
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Binds to the 30S and inhibits tRNA
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What is important to remember for tetracyline absorptions?
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Decreased absorption if taken with multivalent cations (antacids)
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How is tetracycline excreted? What are the unique forms of elimination?
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Excreted: bile and urine
Elimination: 1. Tetracycline: renal 2. Minoclycline: liver metabolized 3. Doxycycline: feces |
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What is Tetracycline's pregnancy category and is it static or cidal?
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Category D
-Bacteriostatic |
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What are some adverse effects of Tetracycline?
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1. GI upsets
2. Diarrhea 3. PHOTOSENSITIVITY 4. Liver and Kidney Toxicity 5. PERMANENT BROWN DISCOLORATION OF TEETH (avoid in children up to 8) |
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Glycylcycline (tigecyclin) have what spectrum? What pregnancy category?
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Broad Spectrum: gram +s, gram -s, anaerobes, no pseudomonas
Pregnancy D |
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What are the adverse effects of glycylcyclines?
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Same as tetracyclines
N/V, hepatotoxicty |
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What is the MOA of Macrolides?
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Binds to the 23S rRNA component of the 50S subunit
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What are Macrolides' clinical uses?
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Respiratory tract infections
-option for penecillin allergic pts. |
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What's the spectrum for Macrolides?
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Relatively Narrow: select gram + and -
-Can work against Mycobacteria |
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Which macrolide is best to give as IV?
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Azithromycin, because erythromycin causes necrosis at IV site
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Which Macrolide is excreted by CYP3A4 and renal?
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Clarithromycin
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Do macrolides have D/D interactions?
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Yes with CYP 450 inhibitor
Eryth and Clarith are potent inhibitors particularily 3A4 |
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Which Macrolide has a prolonged timespan?
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Azithromycin (5 day therapy only, but continues to work after)
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What is the excretion for Erythromycin, Clarithromycin and Azithromycin?
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Eryth: biliary
Clarith: CYP3A4/renal Azith:Biliary/Fecal |
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What are the Macrolide pregnancy categories? Adverse effects?
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Eryth and Azith: Preg B
Clarith: preg C Adverse Effects: 1. GI intolerance 2. Cholestatic hepatitis 3. ototoxicity (high doses of eryth) 4. caridac arrythmias (eryth and clarith > azith) |
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What is the MOA and spectrum of Clindamycin?
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Binds to the 50S subunit
-Relatively narrow spectrum: gram + and anaerobic only! (None against gram -) |
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What are some clinical uses of Clindamycin?
Can PCN allergic use it? Pregnancy category? |
Acne or skin infections
Ok for PCN allergic -Pregnancy B |
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What are the adverse effects of Clindamycin? Static or Cidal?
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Adverse effects:
1. Diarrhea 2. Rash -Bacteriostatic |
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What is unique about the Streptogramins?
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They are a combination of 2 antibiotics (quinupristin/dalfopristin)
Work synergistically together |
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What antibiotics bind to 50S subunit at 2 different sites
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Streptogramins
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When do we use streptogramins?
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Saved for serious gram+ infections (MRSA, VRE)
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What drug should be administered ONLY IN CENTRAL LINES AND DILUTED WITH DEXTROSE?
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Streptogramins
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Are the streptogramins static or cidal?
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Separately they are static, may become bacteriocidal when combined
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What are some adverse effects of Streptogramins?
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1. Thrombophlebitis
2. Arthralgias/myalgias (muscle and joint pain) 3. Increased liver enzymes and hyperbilirubinemia |
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What is the MOA of Oxazolidinones? Are they synthetic or natural?
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Bind to the 50S subunit and inhibits formation of initiation complex
-Synthetic |
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What are the clinical uses for Oxazolidinones?
Spectrum of Action? |
Resistant gram + infections: MRSA and VRE
-For gram + ONLY! Considered broad spectrum gram + drug |
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What is unique about the oral absorption of oxazolidionoes?
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It is 100% bioavailable: same as IV
completely absorbed orally |
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Are oxazolidinones static or cidal? Preg category? Metabolism?
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1. Bacteriostatic
2. Pregnancy C 3. Liver metabolized but nonenzymatic |
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What are the adverse effects of Oxazolidinones?
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GI: N/V/D
Bone marrow suppression: thrombocytopenia, anemia, leukopenia |
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Aminoglycosides us what MOA?
Spectrum of activity? |
MOA: bind to the 30S
Aerobic gram neg only!! (includes pseudomonas) gram +s only in combination therapy to achieve synergy |
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What is the unique distribution of aminoglycosides?
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It is limited to lean body weight
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Are aminoglycosides static or cidal?
Time or concentration dependent? Preg category? |
1. Rapidly bactericidal
2. Concentration dependent killing 3. preg D |
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What is the Post antibiotic effect of aminoglycosides?
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The bacteria fail to grow despite concentrations below MIC
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What class of drugs have the following adverse effects?
1. Reversible Nephrotoxicity 2. IRREVERSIBLE Ototoxicity 3 Neuromuscular blockade (rare) |
Aminoglycosides
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What cautions should you take with administering/dosing of aminoglycosides?
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Dosing is based on lean or adjusted body weight (not toal body weight)
Therapeutic levels associated with improved response. (narrow range) **Extended-interval AMG dosing** (use 2 different doses, some groups are excluded from this type of dosing) |
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What antibiotics alter nucleic Acid metabolism?
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Fluoroquinolones! "Floxacins"
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What is the MOA of Fluoroquinolones?
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Inhibits DNA gyrase and topoisomerase IV which are needed for normal replication.
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Describe the spectrum of activity for the "floxians"
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Gram - organisms, only 2 specific drugs work on pseudomonas
Some newer agents can work against S. pneumonia |
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Are the floxians time or conentration dependent?
Cidal or Static? Pregnancy? |
1. Concentration
2. Bactericidal 3. Pregnancy C |
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What are some common uses for Floxians?
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TRAVELER'S DIARRHEA, Respiratory and Urinary tract infections. Can be used by PCN allergic
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How are Floxian's simiar to tetracyclines?
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They both have impaired absorption when taken with multivalent cations (antacids)
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Which Floxian has a mixed metabolism?
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Cipro
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List the adverse effects of the Floxians
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1. GI (N/V
2. Rashes/hypersensitivity 3. Arthropathy, TENDONITIS 4. increase liver enzyme 5. cardiac arrythmias 6. CNS: dizziness, hallucinations, delirium, seizures |
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Which drugs inhibit Folate Metabolism?
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Trimethoprim/Sulfonamides (BACTRIM)
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Some uses of trimethoprim/sulfamethoxazole?
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1. PCP pneumonia
2. SALMONELLA AND SHIGELLA 3. Newest use: community associate MRSA 4. option for PCN allergy |
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What is the spectrum of activity for Trimethoprim/sulfamethoxzole?
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NARROW!
-Limited gram + and gram- coverage DRUG OF CHOICE FOR PCP PNEUMONIA in immunosuppressed patients (treatment and prophylaxis) |
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Which antibiotic can cause Stevens-Johnson Syndrome and what is it?
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Trimethoprim/Sulfonamides (BACTRIM)
-sloughing off of the skin |
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what are some adverse effects of Trimethoprim/Sulfonamides (BACTRIM)?
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1. STEVENS-JOHNSON
2. hypersensitivity 3. hematologic abnormalities 4. kidney inflammation 5. Hepatitis, pancreatitis 6. KERNICTERUS (encephalopathy) in NEWBORNS (preg C) |
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What are the miscellaneous antiobiotic classes?
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1. Metronidazole
2. Daptomycin 3. Polymyxins |
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what is the MOA for Metronidazole?
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Inhibits DNA Synthesis
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Which antibiotic can treat anaerobic bacteria ONLY!!?
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Metronidazole
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What are the important clinical uses for Metronidazole?
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1. C. diff
2. anaerobic and parasitic infections |
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Does metronidazole have good bioavailability orally?
Preg Cat? |
YES! >90%
-preg B |
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What Drug has the following adverse effects?
1. CNS (ataxia, dysarthria, dizziness, confusion, excitation depression, seizures 2. PERIPHERAL NEUROPATHY 3. GI, METALLIC TASTE!! 4. DISULFIRAM-LIKE REACTIONS (vomit with alcohol) |
metronidazole
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Which drug Inserts its LIPOPHILIC TAIL into gram + cytoplasmic membrane and causes cell death!?
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Daptomycin (Cubicin)
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What are the pharmokinetics for DAPTOMYCIN?
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1. Concentration dep, Bactericidal
2. IV ONLY 3. Preg B 4. small volume of distribution |
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What are the most unique adverse effects of Daptomycin?
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1. Myositis [increase creatine kinase (CK)]
--symptoms of mild/mod muscle pain or weakness plus BPK elevations REVERSIBLE!! |
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Which drug is used primarily as eye or ear drops?
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Polymyxins
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What is the MOA of Polymyxins?
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Act on gram - bacterial cell wall to cause permeability changes in the membrane (cationic detergent)
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Spectrum of Polymyxins?
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Gram-negative ONLY
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Are Polymysins time or concentratoin dependent?
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Concentration dependent
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What are the adverse effects of Polymyxins?
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1. Renal toxicity
2. Neurotoxicity: restlessness, paresthesia, weakness, ataxia, seizures, neuromuscular blockade |
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Which antibiotics act ONLY on Gram +?
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-Penecillin-Resistant Penecillins
-Streptogramins -Oxazolidinones -Daptomycin -Vancomycin |
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Which antibiotics are ONLY for Gram - ?
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-Polymyxins
-Aminoglycosides -Monobactam |
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Which antibiotic is effect on gram + and anaerobes, not gram -?
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Clindamycin
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Which antibiotics are considered Broad spectrum?
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-Antipseudomonal Penecillins
-B-Lactamase Inhibitors -3rd and 4th gen of Cephalosporins -Carbapenems -Chloramphenicol -Glycylcycline - |
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Which antibiotic is used solely to treat anaerobic bacteria?
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Metronidazole
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List the antiobiotics that are gram + and gram -, but NARROW?
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-Natural Penecillins
-Aminopenecilins -1st and 2nd gen Cephalosporins -Tetracyclines -Macrolides -Fluoroquinolones (more gram -) -Trimethoprim/Sulfamethoxazole - |
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Which antibiotic can rupture the Achilles Tendon?
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Fluoroquinolones
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List the Bacteriostatic antiBs
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-Chloramphenicol
-Tetracyclines -Clindamycin -Oxazolidnones - |
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List the Bactericidal antiBs?
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-B-Lactams
-Vancomycin -Aminoglycosides -Fluoroquinolones -Daptomycin |
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Which AntiB's are concentration dependent?
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-Aminoglycosides
-Fluoroquinolones -Daptomycin -Polymyxins |
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Which antiBs are time dependent?
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-B-Lactams
-Vancomycin |