Advanced Pharmacology test 1
Beta lactamase inhibitors - CORRECT ANSWER - Clavulanic acid, sublactam, taxobactam
Unasyn - CORRECT ANSWER - Ampicillin and sulbactam
Augmentin - CORRECT ANSWER - Amoxicillin clavulanic acid
Hapten - CORRECT ANSWER - Drug +plasma protein severe allergic reaction
Mechanisms resistance to beta lactamase - CORRECT ANSWER - Inactivation by beta lactamase, mutation
trans peptidase target, impaired penetration of drug into organism, drug effluent pumps
MRSA - CORRECT ANSWER - Resistant organisms produce PBPs with decreased affinity for binding beta
lactam antibiotics
Impaired penetration of drug into organosm - CORRECT ANSWER - Absence of porins or down regulation
of porins or porins smaller
Drug efflux pumps - CORRECT ANSWER - Nonspecific, spit out whatever bacteria doesn't need, major
mechanism MDR
Prevention of resistance steains - CORRECT ANSWER - Testing, choose right antibiotic, complete course
therapy, don't use antibiotic when not indicated
Mutidrug resistant organisms - CORRECT ANSWER - Organisms that are resistant to 1 or more class of
organisms. Drug efflux pumps
Penicillin - CORRECT ANSWER - Bactericidal
Penicillin adverse effects - CORRECT ANSWER - GI distress, oral/vaginal candidiasis, rash, anaphylaxis
Cephalosporins - CORRECT ANSWER - More stable against beta lactamases, increased range activity
1st generation cephalosporin - CORRECT ANSWER - Cefazolin, cephalexin
G+, susceptible beta lactamase
2,3 generations cephalosporins - CORRECT ANSWER - Broader spectrum,
Increase resistance beta lactamase, increase half life, some cross BBB
4,5 generations cephalosporins - CORRECT ANSWER - Cefepine, excellent resistance most beta
lactamase, excellent CNS penetration, ceftaroline against MRSA
Adverse reactions cephalosporins - CORRECT ANSWER - Hypersensitivity, fever, skin rashes, nephritis,
granulocytopenia, hemolytic anemia, anorexia
Cefotetan - CORRECT ANSWER - Avoid ETOH! Disulfiram like reaction with this cephalosporins
Treatment for C diff from broad spectrum cephalosporin - CORRECT ANSWER - Vancomycin,
,metrondiszole
Example monobactam - CORRECT ANSWER - Aztreonam
IV or IM
Active against G neg only
Tolerated by PCN allergic patiemts
Example carbapenem - CORRECT ANSWER - Imipenem, IV or IM only
Widest spectrum of any beta lactam, must prescribe with cilastin to inhibit first pass elimination by renal
enzyme dehydropeptidase, low crossreactivity for PCNs. Good for meningitis, peritonitis in really sick
patients
Vancomycin - CORRECT ANSWER - Cell wall inhibitor but not beta lactam, glycopeptide structure, best
treatment for MRSA and G+. Only use Italy to treat antibiotic induced colitis, C. difficile and staph
entericolitis
Must monitor peak and trough, poorly absorbed po
Vancomyicin - CORRECT ANSWER - Bacterocidal for G +
Vancomycin - CORRECT ANSWER - Poor oral bioavailability, 90% GFR eliminated, if renal impairments can
have accumulation.
Vancomycin Adverse Effect - CORRECT ANSWER - Ototoxicity if given with aminoglycoside!!
Tissue irritation at injection site, chill and fever
Red man syndrome - CORRECT ANSWER - Vancomycin if Tate of infusion too fast. Histamine release,
hypotension, flush, skin rash. Prevent by 1-2 hr infusion or pretreat with antihistamine
Advantages vancomycin - CORRECT ANSWER - Not susceptible to beta lactamase, no PCN allergy
Classes of protein synthesis inhibitors - CORRECT ANSWER - Tetracycline, macrolides, oxazolidinones and
aminoglycosides
Inhibitors bacterial translation - CORRECT ANSWER - Interfere with bacterial ribosome, may affect
protein synthesis in human cells, complete inhibition of protein synthesis may not be enough to kill
bacteria. Antibiotics bind to bacterial ribosome to block bacterial protein synthesis
Examples of Tetracyclines - CORRECT ANSWER - Tetracycline, oxytetracycline, doxycycline,
demeclocycline
Tetracycline uses - CORRECT ANSWER - H pylori, cholera, acne, tick fever
Elimination tetracycline - CORRECT ANSWER - Bile and urine, Hilary excretion effects flora of lower
regions GI tract
Absorption tetracycline - CORRECT ANSWER - Oral absorption decreased by antacids, dairy Ca, bismuth,
, Fe, food, alkaline pH,
Adverse effects tetracycline - CORRECT ANSWER - B/c interaction with Ca can sequester in bone and
teeth. Don't use in pregnancy or kids less than 8. Also photosensitive
Adverse effects tetracycline - CORRECT ANSWER - With diuretics causes nephrotoxicity. Nausea/vomit,
epigastric, heartburn, diarrhea
Macrolides example - CORRECT ANSWER - Erythromycin, azithromycin, clarithtomycin
Macrolides - CORRECT ANSWER - Broad spectrum, bacteriostatic, at high levels bacteriocidal, enhanced
activity at alkaline pH,
H pylori treatment - CORRECT ANSWER - Clarithromycin and ompeprazole
Macrolides interactions - CORRECT ANSWER - Erythromycin and clarithromycin potent inhibitors of CYP
450!!
Affect blood levels of warfarin, statins, Ca channel blockers, azolve antifungals
Azithromycin does not inhibit CYP450!!!
Macrolides adverse effects - CORRECT ANSWER - GI especially with erythromycin, N/V, diarrhea,
hepatptoxic, flatulemce, jaundice, anorexia. Erythromycin increases GI motility
Adverse effects azythromycin and clarithromycin - CORRECT ANSWER - Less adverse GI than erythro,
longer duration action, increased efficacy and tissue penetration
Oxazolidinones - CORRECT ANSWER - Linezolid, rescue antibiotic, active against drug resistant gram +,
MRSA, VRE.
MOA linezolid - CORRECT ANSWER - Inhibit protein synthesis, prevention of formation of ribosome
complex that initiates protein synthesis, unique binding site, no cross resistance. Resistance caused by
muation of binding site
Adverse effects linezolid - CORRECT ANSWER - Mild thrombocytopenia and neutropenia
Black box linezolid - CORRECT ANSWER - SSRIs and SNRIs , zyvox inhinits MAO, can get serotonin
syndrome
Examples aminoglycosides - CORRECT ANSWER - Streptomycin, gentamicin, tobt
Examples aminoglycosides - CORRECT ANSWER - Streptomycin, gentsmicin, tobramycin, amikacin
Aminoglycosides - CORRECT ANSWER - Bactericidal inhibitors of protein synthesis. Useful against gram
neg, acts at 30s ribosome subunit. Used in combo with other abx for synergistic. Used for gram +
infections that are resistant to other abx
Side effects aminoglycosides - CORRECT ANSWER - Ototoxicity: auditory/vestibular. And Nephrotoxicity.
More toxicity in elderly, renal jnsufficency and dosing >5 days. Avoid use with loop diuretics or
vancomycin or amphotericin.
Beta lactamase inhibitors - CORRECT ANSWER - Clavulanic acid, sublactam, taxobactam
Unasyn - CORRECT ANSWER - Ampicillin and sulbactam
Augmentin - CORRECT ANSWER - Amoxicillin clavulanic acid
Hapten - CORRECT ANSWER - Drug +plasma protein severe allergic reaction
Mechanisms resistance to beta lactamase - CORRECT ANSWER - Inactivation by beta lactamase, mutation
trans peptidase target, impaired penetration of drug into organism, drug effluent pumps
MRSA - CORRECT ANSWER - Resistant organisms produce PBPs with decreased affinity for binding beta
lactam antibiotics
Impaired penetration of drug into organosm - CORRECT ANSWER - Absence of porins or down regulation
of porins or porins smaller
Drug efflux pumps - CORRECT ANSWER - Nonspecific, spit out whatever bacteria doesn't need, major
mechanism MDR
Prevention of resistance steains - CORRECT ANSWER - Testing, choose right antibiotic, complete course
therapy, don't use antibiotic when not indicated
Mutidrug resistant organisms - CORRECT ANSWER - Organisms that are resistant to 1 or more class of
organisms. Drug efflux pumps
Penicillin - CORRECT ANSWER - Bactericidal
Penicillin adverse effects - CORRECT ANSWER - GI distress, oral/vaginal candidiasis, rash, anaphylaxis
Cephalosporins - CORRECT ANSWER - More stable against beta lactamases, increased range activity
1st generation cephalosporin - CORRECT ANSWER - Cefazolin, cephalexin
G+, susceptible beta lactamase
2,3 generations cephalosporins - CORRECT ANSWER - Broader spectrum,
Increase resistance beta lactamase, increase half life, some cross BBB
4,5 generations cephalosporins - CORRECT ANSWER - Cefepine, excellent resistance most beta
lactamase, excellent CNS penetration, ceftaroline against MRSA
Adverse reactions cephalosporins - CORRECT ANSWER - Hypersensitivity, fever, skin rashes, nephritis,
granulocytopenia, hemolytic anemia, anorexia
Cefotetan - CORRECT ANSWER - Avoid ETOH! Disulfiram like reaction with this cephalosporins
Treatment for C diff from broad spectrum cephalosporin - CORRECT ANSWER - Vancomycin,
,metrondiszole
Example monobactam - CORRECT ANSWER - Aztreonam
IV or IM
Active against G neg only
Tolerated by PCN allergic patiemts
Example carbapenem - CORRECT ANSWER - Imipenem, IV or IM only
Widest spectrum of any beta lactam, must prescribe with cilastin to inhibit first pass elimination by renal
enzyme dehydropeptidase, low crossreactivity for PCNs. Good for meningitis, peritonitis in really sick
patients
Vancomycin - CORRECT ANSWER - Cell wall inhibitor but not beta lactam, glycopeptide structure, best
treatment for MRSA and G+. Only use Italy to treat antibiotic induced colitis, C. difficile and staph
entericolitis
Must monitor peak and trough, poorly absorbed po
Vancomyicin - CORRECT ANSWER - Bacterocidal for G +
Vancomycin - CORRECT ANSWER - Poor oral bioavailability, 90% GFR eliminated, if renal impairments can
have accumulation.
Vancomycin Adverse Effect - CORRECT ANSWER - Ototoxicity if given with aminoglycoside!!
Tissue irritation at injection site, chill and fever
Red man syndrome - CORRECT ANSWER - Vancomycin if Tate of infusion too fast. Histamine release,
hypotension, flush, skin rash. Prevent by 1-2 hr infusion or pretreat with antihistamine
Advantages vancomycin - CORRECT ANSWER - Not susceptible to beta lactamase, no PCN allergy
Classes of protein synthesis inhibitors - CORRECT ANSWER - Tetracycline, macrolides, oxazolidinones and
aminoglycosides
Inhibitors bacterial translation - CORRECT ANSWER - Interfere with bacterial ribosome, may affect
protein synthesis in human cells, complete inhibition of protein synthesis may not be enough to kill
bacteria. Antibiotics bind to bacterial ribosome to block bacterial protein synthesis
Examples of Tetracyclines - CORRECT ANSWER - Tetracycline, oxytetracycline, doxycycline,
demeclocycline
Tetracycline uses - CORRECT ANSWER - H pylori, cholera, acne, tick fever
Elimination tetracycline - CORRECT ANSWER - Bile and urine, Hilary excretion effects flora of lower
regions GI tract
Absorption tetracycline - CORRECT ANSWER - Oral absorption decreased by antacids, dairy Ca, bismuth,
, Fe, food, alkaline pH,
Adverse effects tetracycline - CORRECT ANSWER - B/c interaction with Ca can sequester in bone and
teeth. Don't use in pregnancy or kids less than 8. Also photosensitive
Adverse effects tetracycline - CORRECT ANSWER - With diuretics causes nephrotoxicity. Nausea/vomit,
epigastric, heartburn, diarrhea
Macrolides example - CORRECT ANSWER - Erythromycin, azithromycin, clarithtomycin
Macrolides - CORRECT ANSWER - Broad spectrum, bacteriostatic, at high levels bacteriocidal, enhanced
activity at alkaline pH,
H pylori treatment - CORRECT ANSWER - Clarithromycin and ompeprazole
Macrolides interactions - CORRECT ANSWER - Erythromycin and clarithromycin potent inhibitors of CYP
450!!
Affect blood levels of warfarin, statins, Ca channel blockers, azolve antifungals
Azithromycin does not inhibit CYP450!!!
Macrolides adverse effects - CORRECT ANSWER - GI especially with erythromycin, N/V, diarrhea,
hepatptoxic, flatulemce, jaundice, anorexia. Erythromycin increases GI motility
Adverse effects azythromycin and clarithromycin - CORRECT ANSWER - Less adverse GI than erythro,
longer duration action, increased efficacy and tissue penetration
Oxazolidinones - CORRECT ANSWER - Linezolid, rescue antibiotic, active against drug resistant gram +,
MRSA, VRE.
MOA linezolid - CORRECT ANSWER - Inhibit protein synthesis, prevention of formation of ribosome
complex that initiates protein synthesis, unique binding site, no cross resistance. Resistance caused by
muation of binding site
Adverse effects linezolid - CORRECT ANSWER - Mild thrombocytopenia and neutropenia
Black box linezolid - CORRECT ANSWER - SSRIs and SNRIs , zyvox inhinits MAO, can get serotonin
syndrome
Examples aminoglycosides - CORRECT ANSWER - Streptomycin, gentamicin, tobt
Examples aminoglycosides - CORRECT ANSWER - Streptomycin, gentsmicin, tobramycin, amikacin
Aminoglycosides - CORRECT ANSWER - Bactericidal inhibitors of protein synthesis. Useful against gram
neg, acts at 30s ribosome subunit. Used in combo with other abx for synergistic. Used for gram +
infections that are resistant to other abx
Side effects aminoglycosides - CORRECT ANSWER - Ototoxicity: auditory/vestibular. And Nephrotoxicity.
More toxicity in elderly, renal jnsufficency and dosing >5 days. Avoid use with loop diuretics or
vancomycin or amphotericin.
