UAMS P2 - PCol Exam 5 SG

Fluoroquinolones MOA

Bactericidal activity by inhibiting DNA synthesis, blocks Topo IV (gram +) and DNA gyrase (gram -)

Cipro is active against:

A) MSSA

B) Streptococcus pneumoniae

C) Enterococcus faecium

D) Pseudomonas aeruginosa

Pseudomonas aeruginosa

Levofloxacin is active against:

A) Pseudomonas aeruginosa

B) Enterococcus facialis

C) Enterococcus faecium

D) C. Diff

Pseudomonas aeruginosa

Moxifloxacin is active against:

A) MRSA

B) Streptococcus pneumoniae

C) Enterococcus faecium

D) Pseudomonas aeruginosa

Streptococcus pneumoniae

(anaerobes)

Which quinolone is primarily active against anaerobes?

A) Ciprofloxacin

B) Moxifloxacin

C) Levofloxacin

D) Gemifloxacin

Moxifloxacin

Levofloxacin is active against which organism?

A) MRSA

B) Mycoplasma pneumoniae

C) Bacteroides fragilis

D) Enterococcus faecium

Mycoplasma pneumoniae

Delafloxacin is active against which organism?

A) C. difficile

B) Acinetobacter Spp

C) MRSA

D) Enterococcus faecium

MRSA

(only quinolone for MRSA)

ADE of Lomefloxacin (drug specific)

phototoxicity, QTc prolongation

ADE of Sparfloxacin (drug specific)

phototoxicity, QTc prolongation

ADE of Gatifloxacin (drug specific)

hypoglycemia

ADE of Temafloxacin (drug specific)

immune hemolytic anemia

ADE of Trovafloxacin (drug specific)

hepatotoxicity

ADE of Grepafloxacin (drug specific)

cardiotoxicity - QTC prolongation

ADE of Clinafloxacin (drug specific)

Phototoxicity

Fluoroquinolone ADEs (6)

Gastrointestinal,

neurological (peripheral neuropathy),

musculoskeletal,

derm (phototoxicity),

CV (QT prolongation),

Endocrine (Hypo/hyperglycemia)

Which Fluoroquinolone(s) SHOULDN'T be used for UTI?

Moxifloxacin

Which Fluoroquinolone(s) active against community-acquired respiratory organisms?

Levofloxacin, moxifloxacin, gemifloxacin

Which Fluoroquinolone(s) used in HAP/VAP?

Ciprofloxacin, levofloxacin

Which Fluoroquinolone(s) used in Prostitis?

Norfloxacin, Ciprofloxacin, Ofloxacin, Levofloxacin

Which agent inhibits CYP1A2?

A) Levofloxacin

B) Moxifloxacin

C) Delafloxacin

D) Ciprofloxacin

Ciprofloxacin

Which fluoroquinolone does NOT require renal dose adjustments?

A) Moxifloxacin

B) Delafloxacin

C) Ciprofloxacin

D) Levofloxacin

Moxifloxacin

All are ADEs of Fluoroquinolones except:

A) Delirium

B) Hyperkalemia

C) Tendon rupture

D) Hyperglycemia

Hyperkalemia

Which agent is most likely to increase effects of Warfarin?

A) Ciprofloxacin

B) Moxifloxacin

C) Delafloxacin

D) Levofloxacin

Ciprofloxacin

Which agent interacts with Divalent Cations?

A) ibuprofen

B) levothyroxine

C) norfloxacin

D) amoxicillin

Norfloxacin

(Fluoroquinolones interact with divalent cations)

Oxazolidinones Drugs (2)

Tedizolid,

Linezolid

Oxazolidinones best used against

Gram Positive Pathogens (MSSA, VRSA, VRE, MRSA, MRSE)

Oxazolidinones MOA

Bacteriostatic, Binds to 50s ribosomal subunit, preventing protein synthesis

Linezolid ADEs (drug-specific)

Myelosuppression

Which agent inhibits MAO?

A) Tedizolid

B) Clarithromycin

C) Linezolid

D) Sulfamethoxazole-trimethoprim

Linezolid

(not reported for Tedizolid)

Which Oxymetazoline is not FDA approved for pneumonia use?

Tedizolid

Which agent is effective against MRSA?

A) Ciprofloxacin

B) Delafloxacin

C) Moxifloxacin

D) Levofloxacin

Delafloxacin

(MRSA is Gram +, cipro not effective)

Which organism is Ciprofloxacin NOT effective against?

A) MSSA

B) H. Influenza

C) Pseudomonas aeruginosa

D) Legionella

MSSA

(Cipro not effective against Gram + bacteria)

Tetracycline MOA

Bacteriostatic, Reversibly binds to 30s subunit, blocks protein synthesis

Which agent is active against CA-MRSA (community-acquired MRSA)?

A) Tigecycline and Doxycycline

B) Ervacycline and Tigecycline

C) Doxycycline and Minocycline

D) Sarecycline and Omadacycline

Doxycycline and Minocycline

Which agent binds to 30s subunit to suppress protein synthesis?

A) SMX-TMP

B) Tigecycline

C) Clarithromycin

D) Clindamycin

Tigecycline

Which agent binds to 50s subunit to suppress protein synthesis?

A) Azithromycin

B) Gentamicin

C) Tigecycline

D) Doxycycline

Azithromycin

Which organism is Tigecycline NOT active against?

A) VRE

B) ESBL

C) M. pneumoniae

D) Pseudomonas aeruginosa

Pseudomonas aeruginosa

Which organism is Ervacycline NOT active against?

A) C. perfringens

B) ESBL

C) M. pneumoniae

D) Pseudomonas aeruginosa

Pseudomonas aeruginosa

Which organism is Omadacycline NOT active against?

A) C. perfringens

B) ESBL

C) M. pneumoniae

D) Pseudomonas aeruginosa

Pseudomonas aeruginosa

Which agent is active against Parabacteroides distasonis (aka... Anaerobes)?

A) Tigecycline

B) Omadacycline

C) Doxycycline

D) Minocycline

Omadacycline

(new agents are active against Anaerobes)

Which agent is active against VRE?

A) Tigecycline

B) Doxycycline

C) Minocycline

D) Omadacycline

Tigecycline and Omadacycline

(Tigecycline + new agents, omadacycline and eravacycline)

Resistance of Tetracyclines Develops primarily by preventing accumulation of drug inside the cell either by ___________________ or ___________________

decreasing influx; increasing efflux

Which agent requires renal dose adjustments?

A) Doxycycline

B) Ervacycline

C) Tetracycline

D) Tigecycline

Tetracycline

Which agent inhibits P-gp?

A) Sarecycline

B) Ervacycline

C) Tetracycline

D) Tigecycline

Sarecycline

ADEs of Tetracyclines

Teeth discoloration,

GI effects (N/V anorexia),

Phototoxicity,

Mortality

Which agent is the drug of choice for ehrlichiosis?

A) Minocycline

B) Tetracycline

C) Tigecycline

D) Doxycycline

Doxycycline

Tetracyclines for Drug-resistant organisms (MRSA, VRE, ESBL, and CRE)

Tigecycline,

Ervacycline,

Omadacycline

MOA of Nitrofurantoin

bactericidal, forms reactive intermediates which alter ribosomal proteinsMOA of Nitrofurantoin

Which organism is Nitrofurantoin active against?

A) C. Difficile

B) VRE

C) Burgella

D) MRSA

VRE

Nitrofurantoin should not be used when CrCl < ____________

60 mL/min

ADEs of Nitrofurantoin

Gastro (N/V/D),

Hypersensitivity,

CNS

Which is considered first-line for UTIs?

A) Amoxicillin

B) Nitrofurantoin

C) Tetracycline

D) Linezolid

Nitrofurantoin

Fosfomycin MOA

bactericidal, reversible attaches enolpyruvyl transferase (MurA), and blocks bacterial cell wall biosynthesis

Which agent interferes with 1st step of bacterial cell wall synthesis?

A) Nitrofurantoin

B) Metronidazole

C) Fosfomycin

D) Vancomycin

Fosfomycin

Sulfamethoxazole-trimethoprim is active against all EXCEPT:

A) CA-MRSA

B) Stenotrophamonas maltophilia

C) Pneumocystis jirovecii

D) Bacteroides fragilis

Bacteroides fragilis

Which agent is more likely to produce a drug-interaction with linezolid?

A) Atorvastatin

B) Amitriptyline

C) Alprazolam

D) Amiodarone

Amitriptyline

QTc Prolongation has NOT been reported with which agent?

A) Moxifloxacin

B) Doxycycline

C) Clarithromycin

Doxycycline

Which is agent is NOT active vs CA-MRSA?

A) Sulfamethoxazole-Trimethoprim

B) Clindamycin

C) Clarithromycin

D) Doxycycline

Clarithromycin

Azithromycin is NOT active against which organism?

A) Streptococcus pneumoniae

B) Chlamydia spp

C) Pseudomonas aeruginosa

D) Haemophilus influenza

Pseudomonas aeruginosa

Fosfomycin is active against all EXCEPT

A) CRE

B) MRSA

C) Bacteroides fragilis

D) Pseudomonas aeruginosa

Bacteroides fragilis

Which should be avoided with Doxycycline?

A) Sertraline

B) Calcium

C) Atorvastatin

D) Potassium

Calcium

Which is NOT active vs ESBL and CRE organisms?

A) Doxycycline

B) Ervacycline

C) Omadacycline

D) Tigecycline

Doxycycline

Tigecycline is active against all EXCEPT:

A) MRSA

B) Carbapenem-resistant Enterobacteriaceae

C) Pseudomonas aeruginosa

D) Vancomycin-resistant enterococcus

Pseudomonas aeruginosa

Clarithromycin is active against all EXCEPT:

A) Streptococcus pneumoniae

B) Haemophilus influenza

C) Bacteroides fragilis

D) Mycoplasma pneumoniae

Bacteroides fragilis

Which common ADE is associated with Nitrofurantoin?

A) Nephrotoxicity

B) Acute pneumonitis

C) Nausea, vomiting and diarrhea

D) Neuropathy

Nausea, vomiting and diarrhea

Which agent requires renal dose adjustments?

A) Minocycline

B) Doxycycline

C) Tigecycline

D) Ervacycline

Minocycline

Sulfamethoxazole is an inhibitor of _____________

CYP2C9

Trimethoprim is an inhibitor of _____________

CYP2C8 and OCT2

Sulfamethoxazole-Trimethoprim ADEs

GI,

Hematological,

Hyperkalemia,

Nephrotoxicity (Crystalluria),

Dermatological

Which agent is contraindicated in 3rd trimester of Pregnancy?

A) Clindamycin

B) Azithromycin

C) Sulfamethoxazole-Trimethoprim

D) Doxycycline

Sulfamethoxazole-Trimethoprim

Which agent interacts with antifolates?

A) Clindamycin

B) Azithromycin

C) Sulfamethoxazole-Trimethoprim

D) Doxycycline

Sulfamethoxazole-Trimethoprim

Which agent is most likely active against Legionella?

A) Linezolid

B) Doxycycline

C) Imipenem-cilastatin

D) Gentamicin

Doxycycline

Which is active against VRE?

A) Vancomycin

B) Linezolid

C) Amikacin

D) Azithromycin

Linezolid

Which agent is LEAST likely to cover Bacteroides fragilis?

A) Meropenem

B) Amoxicillin-Clavulanate

C) Clindamycin

D) Clarithromycin

Clarithromycin

Cipro is active against all EXCEPT:

A) Streptococcus pneumoniae

B) Mycoplasma spp.

C) E. coli

D) Pseudomonas aeruginosa

Streptococcus pneumoniae

A patient has an E. Coli UTI. Which is most appropriate?

A) Sulfamethoxazole-trimethoprim

B) Dicloxacillin

C) Moxifloxacin

D) Colistin

Sulfamethoxazole-trimethoprim

A patient is diagnosed with an anaerobic lung infection. Which would be most appropriate?

A) Clindamycin

B) Tobramycin

C) Metronidazole

D) Daptomycin

Clindamycin

Which agent is NOT active against CA-MRSA?

A) Sulfamethoxazole-Trimethoprim

B) Clindamycin

C) Azithromycin

D) Doxycycline

Azithromycin

Which agent is active against Pneumocystis jirovecii?

A) Clarithromycin

B) Sulfamethoxazole-trimethoprim

C) Nitrofurantoin

D) Linezolid

Sulfamethoxazole-trimethoprim

Clarithromycin is NOT active against:

A) Streptococcus pneumoniae

B) Chlamydia spp

C) Pseudomonas aeruginosa

D) Haemophilus influenza

Pseudomonas aeruginosa

Which agent is most active against Ehrlichia spp, rickettsia spp, and Borrelia spp (Tick-borne)?

A) Azithromycin

B) Doxycycline

C) Cefuroxime

D) Doripenem

Doxycycline

Fosfomycin is active against all EXCEPT:

A) CRE

B) MRSA

C) Bacteroides fragilis

D) Pseudomonas aeruginosa

Bacteroides fragilis

Which agent inhibits CYP1A2?

A) Ciprofloxacin

B) Levofloxacin

C) Clarithromycin

D) Azithromycin

Ciprofloxacin

Tendon rupture has been reported with which class of antibiotics?

A) Aminoglycosides

B) Macrolides

C) Glycopeptides

D) Fluoroquinolones

Fluoroquinolones

Which agents has strong inhibition of CYP3A4?

A) Erythromycin

B) Azithromycin

C) Linezolid

D) Clarithromycin

Erythromycin and Clarithromycin

(Azith does not inhibit... Linezolid inhibits MAO)

Which agent has the highest risk of GI adverse effects?

A) Clarithromycin

B) Azithromycin

C) Erythromycin

Erythromycin

(Erythromycin>Clarithromycin>Azithromycin)

Macrolides ADEs

QTc Prolongation,

GI effects (Erythromycin has highest),

Hepatotoxicity

Which agent(s) requires Renal dose adjustments?

A) Azithromycin

B) Fidaxomicin

C) Erythromycin

D) Clarithromycin

Erythromycin and Clarithromycin

Macrolide Resistance Mechanisms

Drug Efflux,

Ribosomal Protection,

Hydrolysis,

Mutations that alter 50s ribosomal protein

Macrolide MOA

Bacteriostatic, inhibits 50s Subunit and blocks translocation step

When first approaching an infected patient

Begin with EMPIRIC Therapy,

Then Targeted Therapy

Continue to Optimize Drug Therapy

ISPSRPMD stands for

Indication

Source

Pathogen

Spectrum of Activity

Resistance Patterns

PK/PD

Monitoring

Duration of Therapy

therapy used to treat a probable organism based on disease state (indication), patient risk factors, and local resistance rates

Empiric Therapy

Gram positive stains

Purple

Gram negative stains

red/pink

Gram + or -:

Often seen in pairs, chains, or clusters

Gram positive

Gram + or -:

Often seen in rods or bacilli

Gram negative

4 Resistance patterns done by Bacterial Cells

Efflux pump,

Drug-inactivating enzyme,

altering cell wall/decrease porin production,

modified drug target

Agents that are Bacteriostatic

Erythromycin (Macrolides)

Clindamycin (Lincosamides)

Sulfamethoxazole (Sulfonamides)

Trimethoprim

Tetracyclines

Chloramphenicol

(ECSTaTiC about Bacteriostatics)

Agents that are Bacteriocidal

Vancomycin (Glycopeptides),

Fluoroquinolones

Penicillin (Beta-Lactams)

Aminoglycosides

Cephalosporins/Carbapenems

Metronidazole

(Very Finely Proficient At Cell Murder)