all the antibiotics (kill me pls)

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what are the macrolides

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1

what are the macrolides

erythromycin, clarithromycin, azithromycin

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2

route of erythro

po and iv

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3

route of clarithro

po

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4

route of azithro

iv and po

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5

macrolides moa

bind to 50s ribosomal subunit, inhibiting protein synthesis via blocking of transpeptidation/translocation reactions

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6

are macrolides bacteiostatic or bacteriocidal

static

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7

most common macrolide resistance mechanisms

reduced permeability or active efflux. and modificstion of the ribosomal binding site by a macrolide-inducible or constitutive methylase

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8

are macrolides time or conc. dependant and why

time and idk why because they have PAEs but apparently azithro is conc

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9

are macrolides absorbed well orally

no

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10

which macrolide must be taken on an empty stomach

erythromycin base,PCE, or sterate

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11

macrolide ADRs

stomach discomfort (erythromycin worst), taste disturbances (clarithromycin), QT prolongation, drug int

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12

which macrolide has worst coverage

erythro

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13

coverage of macrolides

very poor gram +

better gram - for resp pathogens (h flu except erythro, all cover m cattarrhalis)

chlamidophilia

azithro covers salmonella shigella

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14

what is azithro DOC for

chlamydia trachomatis

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15

what are the tetracyclines

doxy,mino,tetra

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16

tetracyclines route

all po

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17

tetracyclines moa

bind to 30s ribosomal subunit, inhibiting protein synthesis

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18

most common mechanism of bacterial resistance for tetracyclines

decreased intracellular accumulation due to efflux by active transport protein pump

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19

are tetracyclines bacteriostatic or cidal

static

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20

are tetracyclines time or conc dependant

time (but they have PAEs)

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21

which tetracyclines are absorbed well orally

all except tetra

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22

which tetracyclines should be taken with food

mino,doxy - avoid milk

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23

which tetra should be taken on empty stomach

tetra

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24

tetracycline ADRs

GI upset, esophageal ulceration with doxy, photosensitivity, discolored baby teeth, vestibular side effects, bind to divalent cations (AVOID W MILK), least likely to cause c diff

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25

tetracycline coverage

MSSA, MRSA (except tetra), h flu/mcat, peptostrep, chlamydophilia and m pneumoniae

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26

what is doxy DOC in

chlamidophilia and m pneumoniae (walking pneumonia), chlamydia

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27

what are all tetracyclines DOC in

M pneumoniae

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28

what are the quinolones

ciprofloxacin, norfloxacin, levofloxacin, moxifloxacin

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29

cipro route

IV and PO

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30

norfloxacin route

po

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31

levo route

IV and PO

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32

moxi route

IV and PO

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33

what coverage do flouroquinolones widely lack

gram +

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34

flouroquinolones moa

block bacterial DNA synthesis by inhibiting bacterial topoisomerase II (DNA gyrase) and topoisomerase IV

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35

which quinolone is least likely to get resistance

moxifloxacin

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36

what leads to moxifloxacin resistance

overuse and inapropriate use of cipro and levo

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37

are quinolones bacteriocidal or static

cidal

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38

are quinolones conc or time dependant

conc

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39

which quinolone does not require renal adjustment

moxi

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40

most common ADR with quinolones

GI upset

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41

quinolones other adrs

qt prolongation, photosensitivity, binds to divalent cations, affects sugars, cns toxicity, arthropathy, tendinopathy, risk of aortic rupture

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42

quinolone coverage

strep and staph (NOT CIPRO), all easy to kill gram - except n meningitidis, all SPACE except actinobacter and moxi has no pseudomonas, chlamidophilia and m pneumonia

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43

what is cipro DOC in

shigella, pseudomonas

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44

what is levo DOC in

h flu, shigella, pseudomonas, chlamidophilia, chlamydia trachomatis

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45

what is moxi DOC in

h flu, chlamophilia,

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46

which quinolones include pseudomonas

cipro,levo

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47

which quinolone(s) (possibly) treat bfrag

moxi

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48

what are the aminoglycosides

gentamycin,tobramycin,amikacin

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49

route of aminoglycosides

IV

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50

aminoglycosides MOA

binds to 30s subunit ribosomal proteins and results in defective cell membrane

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51

are aminoglycosides bactericidal or static

cidal

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52

is aminoglycoside killing time or conc. dependant

concentration

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53

how long is aminoglycosides post antibiotic effect

6 hrs

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54

aminoglycoside ADR

nephrotoxicity (see less now due to od dosing), ototoxicity, neuromuscular blockade

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55

what type of coverage do aminoglycosides have

gram -

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56

when do aminoglycosides have gram + coverage

synergistically (ex: gentamycin + vancomycin)

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57

aminoglycosides bacteria coverage

easy to kill g-:e coli, shigella, salmonella, kleibsella, proteus

most hard to kill g- (except acinetobacter)

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58

vancomycin route

IV and PO

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59

vancomycin moa

inhibits cell wall synthesis by binding to the D-Ala-D-Ala terminus of nascent peptidoglycan pentapeptide. this inhibits transglcosylase, preventing further elongation of peptidoglycan and cross linking. peptidoglycan is weakened and the cell becomes susceptible to lysis and cell membrane is damaged

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60

is vancomycin killing time or conc dependant

time

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61

what route of vancomycin is used to treat c diff

po

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62

is vancomycin bactericidal or static

cidal

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63

vancomycin resistance mechanisms

due to synthesis of unusually thickened walls (more peptidoglycan layers), the vancomycin binds to the extra layers and becomes sequestered within the cell wall and is unable to reach site of action. (VRE, VISA)

due to modification of the D-Ala-D-Ala binding site of the peptidoglycan building block in which the terminal D-Ala is replaced by D-lactate, resulting in loss of a critical hydrogen bond that facilitates high affinity binding of vancomycin to its target (VRSA)

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64

what type of coverage does vancomycin have

gram + only basically

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65

what is vancomycin DOC for

viridians strep, MSSA, C diff (PO), MRSA, enterococcus

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66

when should vancomycin be reserved for

when other antibiotics cannot be used due to ADR/allergies, or when bacteria is resistant to other antibiotics

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67

vancomycin ADRs

infusion reactions, ototoxicity (uncommon but can occur with consistently high peaks), nephrotoxicity (uncommon)

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68

clindamycin route

PO and IV

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69

clindamycin moa

binds to 50s ribosomal subunit, inhibiting protein synthesis

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70

is clindamycin bactericidal or static

static

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71

clindamycin resistance mechanisms

mutation of the ribosomal receptor site, modification of the receptor by a constitutively expressed methylase, enzymatic inactivation of clindamycin

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72

clindamycin coverage

gram + only (strep, mssa, l mono, peptostrep)

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73

clindamycin ADR

diarrhea- most likely to cause C diff

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74

trimethoprim and sulfamethoxazole route

IV and PO

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75

TMP-SMX moa

sulfa- inhibits bacterial synthesis of dihydrofolic acid by compeititon with para-aminobenzoic acid

tmp- blocks production of tetrahydrofolic acid from dihydrofolic acid by reversibly inhibiting the required enzyme, dihydrofolate reductase, bacterial dihydrofolic acid reductase

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76

is TMP-SMX bactericidal or static

cidal together (static on own)

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77

TMP-SMX general coverage type (gram +,-,etc)

variety of gram +, gram - and other miscellaneous

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78

TMP-SMX ADR

NVD, skin rashes (SJS and TEN), photosensitivity, rash, pruritism bone marrow toxicity, increased serum creatinine, increased K, decreased Na and possible crystalluria, possible teratogenicity and increased risk for kernicterus (avoid in third trimester)

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79

nitrofurantoin MOA

drug gets reduced by bacterial flavoproteins to reactive intermediates, which inactivate or alter bacterial ribosomal proteins and other macromolecules, which causes inhibition of vital biochemical processes of aerobic energy metabolism and the synthesis of DNA, RNA, cell wall, protein

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80

where are therapeutic concentrations of nitrofurantoin achieved

urine only

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81

is nitrofurantoin bactericidal or static

cidal

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82

nitrofurantoin coverage type

some gram + and -

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83

what are nitrofurantoin exclusively used for

UTI

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84

ADR of nitrofurantoin

loss of appetite, nausea, vomiting, darkens urine, GI upset, nausea, headache, SJS/TEN (rare), hepatic reactions (rare), neuropathy/pulmonary fibrosis/hepatic fibrosis (long term use), increased risk of hemolysis in those with G6PD deficiency and in the third trimester/delivery with newborn

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85

fosfomycin MOA

inactivates enolpyruvyl transferase, ultimately inhibits bacterial cell wall synthesis. also decreases adherence of bacteria to epithelial cells of the urinary tract

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86

fosfomycin general coverage type

some gram + and some gram -

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87

fosfomycin ADRs

GI upset, diarrhea, headache, hypokalemia

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88

bacteria covered by TMP-SMX

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89

nitrofurantoin bacteria coverage

e coli and klebsiella, s saphrocytes

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90

metronidazole moa

passive diffusion into cytoplasm of anaerobic bacteria where transport proteins such as ferredoxin transfer electrons to the nitro group of metronidazole forming a nitroso free radical, creating a concentration gradient for intracellular transport of metronidazole where the free radical of metronidazole interacts with intracellular DNA resulting in inhibition of DNA synthesis and degradation and ultimately bacterial death

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91

what types of organisms is metronidazole used for

anaerobic, parasitic

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92

metronidazole ADRs

disulfiram like reactions when taken with alcohol (nausea, vomiting, ab cramps, headache), GI upsetm metallic taste, headache, vaginitis, peripheral/optic neuropathy (long term use), neurotoxicity (rare)

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93

moa of beta lactams

bind to penicillin binding proteins (PBP) which cause the peptidoglycan barrier to not form properly, causing cell lysis

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94

most common mechanisms of resistance to beta lactams

enzymatic destruction by beta lactamases and altered PBP binding sites

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95

are beta lactams bacteriocidal or static

cidal

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96

what type of killing do beta lactams have (____ dependant)

time

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97

most common ADR with beta lactams

hypersensitivity reactions

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98

other adrs of beta lactams

hematologic ADRs at high dose/long durations, neurological events at high doses, C diff

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99

what type of rash with penicillin is NOT indicative of a true IgE mediated allergy

delayed rashes after first few doses or days and no itchiness or hives

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100

if someone has non urticaria rash with penicillin can you give beta lactams

when risk of true allergy is low, can use cephalosporin with a dissimilar side chain

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