PHAR 506 Exam 1 Review Answers - Pharmacology Antibiotics PDF

PHAR 506 Exam 1 Review Rho Chi Review Series Antibacterial Pharmacology Which of the following antibiotics are considered beta-lactams? Select all that apply A. Monobactams B. Carbapenems C. Cephalosporins D. Fluoroquinolones E. Aminoglycosides F. Penicillins BONUS: What are elem...

PHAR 506 Exam 1 Review Rho Chi Review Series Antibacterial Pharmacology Which of the following antibiotics are considered beta-lactams? Select all that apply A. Monobactams B. Carbapenems C. Cephalosporins D. Fluoroquinolones E. Aminoglycosides F. Penicillins BONUS: What are elements of their general recognizable structure? Which of the following antibiotics are considered beta-lactams? Select all that apply A. Monobactams B. Carbapenems C. Cephalosporins D. Fluoroquinolones E. Aminoglycosides F. Penicillins BONUS: What are elements of their general recognizable structure? Thiazolidine and beta-lactam ring Which of the following statements are FALSE concerning beta-lactams? A. They inhibit cell wall synthesis by inhibiting cross-linking B. Time above MIC determines efficacy C. They are generally bacteriostatic D. They have low oral bioavailability E. They generally have poor CNS penetration F. They generally require adjustment in renal insufficiency G. They generally have a short half life and require frequent dosing Which of the following statements are FALSE concerning beta-lactams? A. They inhibit cell wall synthesis by inhibiting cross-linking B. Time above MIC determines efficacy C. They are generally bacteriostatic D. They have low oral bioavailability E. They generally have poor CNS penetration. Except ceftriaxone and cefotaxime F. They generally require adjustment in renal insufficiency, except nafcillin, oxacillin, ceftriaxone, and cefoperazone G. They generally have a short half life and require frequent dosing, except ceftriaxone What is the most common mechanism of resistance to beta-lactams? A. Modification of target PBP B. Impaired penetration into the cell C. Efflux pumps D. Inactivation of antibiotics enzymatically by beta-lactamases BONUS: What are some drugs that contain beta-lactamase inhibitors? What is the most common mechanism of resistance to beta-lactams? A. Modification of target PBP B. Impaired penetration into the cell C. Efflux pumps D. Inactivation of antibiotics enzymatically by beta-lactamases BONUS: What are some drugs that contain beta-lactamase inhibitors? Augmentin: amoxicillin/clavulanic acid ampicillin/sulbactam piperacillin/tazobactam Which of the following cephalosporin: generation pairs are correct? A. Cefepime: 2nd B. Cefazolin: 3rd C. Ceftazidime: 3rd D. Ceftaroline: 2nd In general, what is the general trend of antimicrobial coverage through the generations? Which of the following cephalosporin: generation pairs are correct? A. Cefepime: 2nd B. Cefazolin: 3rd C. Ceftazidime: 3rd D. Ceftaroline: 2nd In general, what is the general trend of antimicrobial coverage through the generations? Less gram positive, more gram negative What antibiotic has coverage similar to ceftazidime and is reserved for patients with a penicillin allergy? A. Ertapenem B. Aztreonam C. Micafungin D. Ampicillin What else can you do for patients with allergies to antibiotics? What antibiotic has coverage similar to ceftazidime and is reserved for patients with a penicillin allergy? A. Ertapenem B. Aztreonam C. Micafungin D. Ampicillin What else can you do for patients with allergies to antibiotics? Desensitization True or False Quinolones Quinolones have the same mechanism of action for gram negative and gram positive bacteria Are generally bacteriostatic Can cause arthropathy and tendinopathy Require separation from multivitamins Do NOT cause QT prolongation True or False Quinolones Quinolones have the same mechanism of action for gram negative and gram positive bacteria: False topoisomerase inhibitors for gram positive and DNA gyrase for gram negative Are generally bacteriostatic: False, bactericidal for susceptible bugs Can cause arthropathy and tendinopathy, True, counseling point Require separation from multivitamins, True, binds to divalent cations Do NOT cause QT prolongation, False What is the spectrum of activity for macrolides? Select all that apply A. Gram + including MSSA, Strep pneumonia B. Gram - including Haemophilus influenza C. Gram - including enterobacteriaceae D. Atypicals What are the four macrolides? Rank their gram positive and gram negative activity What is the spectrum of activity for macrolides? Select all that apply A. Gram + including MSSA, Strep pneumonia B. Gram - including Haemophilus influenza C. Gram - including enterobacteriaceae D. Atypicals What the four macrolides? Clarithromycin, telithromycin, erythromycin, azithromycin Rank their gram positive and gram negative activity Gram positive: T > C > E > A Gram negative: A > C > E > T Which of the following antibiotics do NOT cause QT prolongation? A. Azithromycin B. Fluconazole C. Clarithromycin D. Ertapenem E. Pentamidine Which of the following antibiotics do NOT cause QT prolongation? A. Azithromycin B. Fluconazole C. Clarithromycin D. Ertapenem E. Pentamidine Which of the following are risk factors for QT prolongation? A. Female sex B. Heart disease C. Hypokalemia D. Advanced age E. Organ dysfunction F. Multiple QT prolongation agents G. All of the above Which quinolone causes the least amount of QT prolongation? Which of the following are risk factors for QT prolongation? A. Female sex B. Heart disease C. Hypokalemia D. Advanced age E. Organ dysfunction F. Multiple QT prolongation agents G. All of the above Which quinolone causes the least amount of QT prolongation? moxi > Cipro > levo If a patient develops a seizure caused by antibiotics, what is the prefered treatment? A. Phenytoin B. Phenobarbital C. Levetiracetam D. Alprazolam If a patient develops a seizure caused by antibiotics, what is the prefered treatment? A. Phenytoin B. Phenobarbital C. Levetiracetam D. Alprazolam True or False: Antibiotic induced Seizures Neonates are at an increased risk of penicillin induced seizures Patients treated for meningitis may be predisposed to seizures Carbapenems have a higher incidence than penicillins Risk factors include advanced age, high dose, and renal insufficiency True or False: Antibiotic induced Seizures Neonates are at an increased risk of penicillin induced seizures Patients treated for meningitis may be predisposed to seizures Carbapenems have a higher incidence than penicillins Risk factors include advanced age, high dose, and renal insufficiency TRUE! Susceptibility/ The ABC’s of MIC’s Which of the following must be kept constant when determining MIC in the lab? More than 1 A. Number of bacteria B. Panel of antibiotics C. Incubation times D. Drug concentration How many bacterial isolates are generally incubated? 3rtapenem Which of the following must be kept constant when determining MIC in the lab? More than 1 A. Number of bacteria B. Panel of antibiotics C. Incubation times D. Drug concentration How many bacterial isolates are generally incubation? 10^5 - 10^6 What is the difference between microdilution and macrodilution? A. Macrodilution does not provide an exact MIC while microdilution does B. More antibiotic concentrations can be tested using microdilutions C. Microdilutions are quicker than macrodilutions What is the difference between microdilution and macrodilution? A. Macrodilution does not provide an exact MIC while microdilution does B. More antibiotic concentrations can be tested using microdilutions C. Microdilutions are quicker than macrodilutions Macrodilutions provide a specific MIC but take longer as they can test more antibiotic concentration Microdilutions only provide an S/I/R rating but are quicker What is the difference between susceptible, intermediate and resistant bacteria on a susceptibility report? What is the difference between susceptible, intermediate and resistant bacteria on a susceptibility report? What is the difference between bacteriostatic and bacteriocidal when performing resistance testing? What is the difference between bacteriostatic and bacteriocidal when performing resistance testing? What is the difference between an E-test and Kirby-Bauer? A, Kirby-Bauer’s give exact MIC’s while E-tests give S/I/R readings B. Only Kirby-Bauer is a diffusion assay C. They are exactly the same D. None of the above What is the difference between an E-test and Kirby-Bauer? A, Kirby-Bauer’s give exact MIC’s while E-tests give S/I/R readings B. Only Kirby-Bauer is a diffusion assay C. They are exactly the same D. None of the above Both are diffusion assays, E-tests give exact MIC’s while Kirby-Bauer’s get S/I/R readings What is an antibiogram? Do they differ per institution? Yes! Can they differ within an institution? Yes! UIC’s ED is different than general admitted patients  Chemistry and Pharmacology of Antimicrobials I, II, III, IV, and V Dr. Mankin 200 slides….. Antibiotic MOA Summary Cell Wall Inhibitors Which statement is false about peptidoglycan biosynthesis? A. Gram positive bacteria have a thick, unstructured outer layer of peptidoglycan that makes the cell rigid while gram negative bacteria have a thin, organized layer of peptidoglycan by an inner and outer membrane B. Lipid 4, the building block of peptidoglycan polymers, is synthesized in the cell cytoplasm, diffuses across the inner membrane, then attaches to the growing polymer C. D-ala d-ala cross linking accounts for the rigidity of the cell wall and is catalyzed by transpeptidase Which statement is false about peptidoglycan biosynthesis? A. Gram positive bacteria have a thick, unstructured outer layer of peptidoglycan that makes the cell rigid while gram negative bacteria have a thin, organized layer of peptidoglycan by an inner and outer membrane B. Lipid 4, the building block of peptidoglycan polymers, is synthesized in the cell cytoplasm, diffuses across the inner membrane, then attaches to the growing polymer - LIPID II C. D-ala d-ala cross linking accounts for the rigidity of the cell wall and is catalyzed by transpeptidase What statement is true about beta-lactams? A. Each subsequent generations of cephalosporins has increased gram positive coverage B. Carbapenems can be given IV, PO and IM C. A way to avoid beta-lactamase activity is with the addition of a bulky side chain D. Hydrophobic side chains interfere with penicillin passage through Gram-positive membrane porins. E. Acid labile drugs such as penicillin G should be given orally What statement is true about beta-lactams? A. Each subsequent generations of cephalosporins has increased gram positive coverage decreased gram + coverage B. Carbapenems can be given IV, PO and IM are acid labile - can only be given IV C. A way to avoid beta-lactamase activity is with the addition of a bulky side chain - TRUE D. Hydrophobic side chains interfere with penicillin passage through Gram-positive membrane porins. Gram negative membrane porins E. Acid labile drugs such as penicillin G should be given orally EWG groups decrease rate of acid hydrolysis, amoxicillin/cloxacillin are more acid stable and can be given orally What aspect of penicillin improvements resulted in broadening their spectrum of activity? A. Introduction of more hydrophobic groups B. Introduction of more polar groups Why does vancomycin have essentially no gram negative activity? What aspect of penicillin improvements resulted in broadening their spectrum of activity? A. Introduction of more hydrophobic groups B. Introduction of more polar groups Polar groups facilitate passage through porins Why does vancomycin have essentially no gram negative activity? Their outer membranes are impermeable to large glycopeptide molecules Which statement is false about carbapenems? A. Imipenem is susceptible to rapid hydrolysis by human dehydropeptidase I found in the renal brush border, so it is often administered with cilastatin, a DHP-I inhibitor B. Carbapenems can target an additional enzyme of the cell wall biosynthesis, Ld transferase which can bypass the need for Tpase C. Carbapenems show excellent activity against some gram-positive strains which developed resistance to penicillins and cephalosporins D. Imipenem, meropenem, and ertapenem can be all be given for pseudomonal coverage Which statement is false about carbapenems? A. Imipenem is susceptible to rapid hydrolysis by human dehydropeptidase I found in the renal brush border, so it is often administered with cilastatin, a DHP-I inhibitor B. Carbapenems can target an additional enzyme of the cell wall biosynthesis, Ld transferase which can bypass the need for Tpase C. Carbapenems show excellent activity against some gram-positive strains which developed resistance to penicillins and cephalosporins also have activity against ESBLs D. Imipenem, meropenem, and ertapenem can be all be given for pseudomonal coverage Ertapenem does not cover pseudomonas VRSA or VISA Unused D-ala D-ala that serve as a sponge for vancomycin D-ala D-lactate coded for by the Van gene Have an abnormal cell well and are fairly sick More “fit” strain S. Aureus: VRSA or VISA Unused D-ala D-ala that serve as a sponge for vancomycin VISA D-ala D-lactate coded for by the Van gene VRSA Have an abnormal cell well and are fairly sick VISA More “fit” strain VRSA What are the following drugs MOA? Fosfomycin Bacitracin Vancomycin Colistin BONUS: T/F Dalbavancin binds proteins very tightly and can therefore be given once a week. What are the following drugs MOA? Fosfomycin - inhibits MurA, an enzyme involved in lipid II synthesis Bacitracin - inhibits dephosphorylation of bactoprenol which moves lipid II across the cytoplasmic membrane Vancomycin - binds tightly to D-ala D-ala residues preventing peptidoglycan polymerization and transpeptidation Colistin - disrupts the outer membrane by displacing Mg2+ and Ca2+ ions, disrupts inner membrane by acting as a detergent (hydrophobic side chain) BONUS: T/F Dalbavancin binds proteins very tightly and can therefore be given once a week. TRUE Inhibitors of Protein Synthesis Ribosome Review Questions What is the function of the large subunit? What is the function of the small subunit? Why is the ribosome a preferred antibiotic target? Ribosome Review Questions Which statements are false about macrolides? A. Indicated for upper and lower respiratory infections B. Macrolides bind to the large ribosomal subunits in the nascent peptide tunnel C. Macrolides partially obstruct the entry tunnel, blocking amino acids from entering the ribosome D. Macrolides completely block the exit tunnel and inhibit synthesis of all proteins E. New macrolides can be synthesized using a “lego-like” chemical synthesis computer program Which statements are false about macrolides? A. Indicated for upper and lower respiratory infections B. Macrolides bind to the large ribosomal subunits in the nascent peptide tunnel C. Macrolides partially obstruct the entry tunnel, blocking amino acids from entering the ribosome D. Macrolides completely block the exit tunnel and inhibit synthesis of all proteins - only proteins with MAMs E. New macrolides can be synthesized using a “lego-like” chemical synthesis computer program Macrolides: What is the importance of: A2058 Keto-group Alkyl-aryl side chain Increasing generations Whatistheimportanceof A2058 Macrolidesinteractprimarilyorexclusivelywith rRNA:the contact ofdesosamine withA2058 isparticularlyimportantand isthemaintarget oftheresistance mechanisms. Keto-group Possessionofthe keto group insteadofthecladinosesugar,whichaccounts for betteractivity againsttheresistantstrains Alkyl-aryl sidechains Addition to ketolides(telithromycin) makesadditionalcontactswith the ribosome, increasing affinity ofthedrug Increasing generations Betteracid stability, broaderspectrums, activityagainst resistant strains How do the following resistance mechanisms work? Erm MsrE TolC Mef How do the following resistance mechanisms work? Erm - a methyltransferase that methylates A2058, dimethylation of A2058 displaces a critical molecule of water required for macrolide binding MsrE - ribosome protection, removes macrolide from ribosome TolC - multidrug efflux pumps Mef - macrolide-specific efflux pumps Name an example of an oxazolidinone: True or False 1. Oxazolidinones cover primary gram-negative pathogens 2. Linezolid binds to the small ribosomal subunit in the catalytic center and clashes with the placement of aminoacyl-tRNA when alanine is in the penultimate position 3. Reversible myelosuppression is a side effect 4. A spontaneous mutation of one copy of 23S rRNA is enough to confer resistance to oxazolidinones Name an example of an oxazolidinone: Linezolid True or False 1. Oxazolidinones cover primary gram-negative pathogens: FALSE 2. Linezolid binds to the small ribosomal subunit in the catalytic center and clashes with the placement of aminoacyl-tRNA when alanine is in the penultimate position: False, large ribosomal subunit 3. Reversible myelosuppression is a side effect: TRUE 4. A spontaneous mutation of one copy of 23S rRNA is enough to confer resistance to oxazolidinones: False True or False? The cfr A2503 mutation causes resistance to all oxazolidinones Clindamycin is an example of a lincosamide Lincosamides cover aerobic gram-negative pathogens Methylation of A2503 causes resistance to lincosamides by Erm methyltransferase True or False? The cfr A2503 mutation causes resistance to all oxazolidinones: False, tedizolid lacks an acetamindomethly chain and its smaller side chain is compatible with this additional methyl Clindamycin is an example of a lincosamide: True Lincosamides cover aerobic gram-negative pathogens: False, anaerobic gram-positive pathogens Methylation of A2503 causes resistance to lincosamides by Erm methyltransferase: False, A2058 What is the most appropriate use of streptogramins? A. E. coli B. H. influenza C. VRE D. C. botulinum What is the most appropriate use of streptogramins? A. E. coli B. H. influenza C. VRE (Vancomycin-resistant Enterococcus faecium) D. C. botulinum Which streptogramin: MOA pairs are correct? May be more than 1 A. Quinupristin: catalytic center B. Quinupristin: exit tunnel C. Dalfopristin: exit tunnel D. Dalfopristin: catalytic center E. All of the above F. None of the above Which streptogramin: MOA pairs are correct? May be more than 1 A. Quinupristin: catalytic center B. Quinupristin: exit tunnel C. Dalfopristin: exit tunnel D. Dalfopristin: catalytic center E. All of the above F. None of the above Steptogramin A (Dalfopristin) + Streptogramin B (Quinupristin) Resistance Mechanism Matching 1. Acetyltransferase that modifies and A. Vga inactivates dalfopristin B. Msr 2. Lyase that opens the central circle of C. Lsa quinupristin D. Vat 3. Removes macrolides and streptogramin E. Vgb B from ribosomes 4. Removes lincosamides and streptogramin A from ribosomes 5. Removes streptogramin A from ribosomes 6. Involved in ribosome protection Resistance Mechanism Matching 1. Acetyltransferase that modifies and A. Vga inactivates dalfopristin D B. Msr 2. Lyase that opens the central circle of C. Lsa quinupristin E D. Vat 3. Removes macrolides and streptogramin E. Vgb B from ribosomes B 4. Removes lincosamides and streptogramin A from ribosomes C 5. Removes streptogramin A from ribosomes A 6. Involved in ribosome protection ABC What is the mechanism of action of retapamulin? A. Inhibits initiation of transcription B. Inhibits initiation of translation C. Binds to the peptidyl transferase center in the small ribosomal subunit D. Interferes with placement of rRNA in the peptidyl transferase center What is the mechanism of action of retapamulin? A. Inhibits initiation of transcription B. Inhibits initiation of translation C. Binds to the peptidyl transferase center in the small ribosomal subunit D. Interferes with placement of rRNA in the peptidyl transferase center Binds to the peptidyl transferase center in the large ribosomal subunit. Interferes with the placement of tRNA substrates in the peptidyl transferase center. Cfr methylated A2503 also confers resistance to pleuromutilins Name 3 aminoglycosides Which of the following false? A. Aminoglycosides flip out two guanines in the large subunit rRNA and allows it to accept incorrectly matched mRNA and tRNA B. The effect of aminoglycosides can be enhanced due to self-promoted uptake. C. Aminoglycosides are not selective and affect both bacterial and eukaryotic ribosomes. D. Mechanisms of resistance to aminoglycosides include N-acetylation, O-phosphorylation, and O-adenylation. Name 3 aminoglycosides: amikacin, tobramycin, gentamicin Which of the following false? A. Aminoglycosides flip out two guanines in the large subunit rRNA and allows it to accept incorrectly matched mRNA and tRNA B. The effect of aminoglycosides can be enhanced due to self-promoted uptake. C. Aminoglycosides are not selective and affect both bacterial and eukaryotic ribosomes. D. Mechanisms of resistance to aminoglycosides include N-acetylation, O-phosphorylation, and O-adenylation. What are 2 possible side effects of aminoglycoside therapy? Are aminoglycosides bacteriostatic or bacteriocidal? What are 2 possible side effects of aminoglycoside therapy? Nephrotoxicity and ototoxicity Are aminoglycosides bacteriostatic or bacteriocidal? Bacteriocidal What is the mechanism of action of tetracyclines? A. Binds to the large ribosomal subunit and blocks binding of aminoacyl-tRNA to the ribosome B. Binds to the small ribosomal subunit and blocks binding of aminoacyl-tRNA to the ribosome C. Binds to the large ribosomal subunit and blocks binding of aminoacyl-rRNA to the ribosome D. Binds to the small ribosomal subunit and blocks binding of aminoacyl-rRNA to the ribosome Is tigecycline more potent or doxycycline? What is the mechanism of action of tetracyclines? A. Binds to the large ribosomal subunit and blocks binding of aminoacyl-tRNA to the ribosome B. Binds to the small ribosomal subunit and blocks binding of aminoacyl-tRNA to the ribosome C. Binds to the large ribosomal subunit and blocks binding of aminoacyl-rRNA to the ribosome D. Binds to the small ribosomal subunit and blocks binding of aminoacyl-rRNA to the ribosome Is tigecycline more potent or doxycycline? Tigecycline Which of the following is false? A. Epimerization improves activity of tetracyclines. B. Tetracyclines enter Gram negative cells through potential-driven uptake through porins, while they enter Gram positive cells through diffusion. C. Transmembrane efflux pumps affect all generations of tetracyclines, including tigecycline. D. Tet(M) and Tet(O) proteins provide ribosome protection against tetracyclines Which of the following is false? A. Epimerization improves activity of tetracyclines. B. Tetracyclines enter Gram negative cells through potential-driven uptake through porins, while they enter Gram positive cells through diffusion. C. Transmembrane efflux pumps affect all generations of tetracyclines, including tigecycline. D. Tet(M) and Tet(O) proteins provide ribosome protection against tetracyclines. Drugs that affect RNA/DNA/Folate Biosynthesis What is the mechanism of rifampicin? A. Inhibitor of bacterial DNA polymerase B. Inhibitor of bacterial RNA polymerase C. Binds to the sigma subunit of RNA polymerase D. Binds to the beta subunit of DNA polymerase What is an adverse effect of rifampicin? What is the mechanism of rifampicin? A. Inhibitor of bacterial DNA polymerase B. Inhibitor of bacterial RNA polymerase C. Binds to the sigma subunit of RNA polymerase D. Binds to the beta subunit of DNA polymerase What is an adverse effect of rifampicin? Red urine, sweat, tears True or False? Sulfamethoxazole and Trimethoprim act on the same enzyme to inhibit folate synthesis Sulfonamides inhibit the activity of dihydropteroate synthase by competing with PABA Bactrim covers gram-positive pathogens and gram-negative pathogens True or False? Sulfamethoxazole and Trimethoprim act on the same enzyme to inhibit folate synthesis: False, sulfonamides inhibit dihydropteroate synthase and trimethoprim inhibits dihydrofolate reductase Sulfonamides inhibit the activity of dihydropteroate synthase by competing with PABA: True Bactrim covers gram-positive pathogens and gram-negative pathogens: True Which of the following are not quinolones? A. Nalidixic acid B. Levofloxacin C. Daptomycin D. Novobiocin Which of the following are not quinolones? A. Nalidixic acid B. Levofloxacin C. Daptomycin D. Novobiocin - DNA gyrase inhibitor What is the main target of quinolones? A. Large subunit of the ribosome B. DNA gyrase C. Topoisomerase 2 D. Topoisomerase 4 What is the main target of quinolones? A. Large subunit of the ribosome B. DNA gyrase - Gram - C. Topoisomerase 2 D. Topoisomerase 4 - Gram + Which statement is false about quinolones? A. Since bacterial topoisomerases are structurally similar to eukaryotic topoisomerases, that is why there are so many side effects with these agents B. Bacteria need to have multiple different mutations before a decrease effect takes place C. Novobiocin can be used synergistically with quinolones D. Quinolones bind to the catalytic subunit B. Which statement is false about quinolones? A. Since bacterial topoisomerases are structurally similar to eukaryotic topoisomerases, that is why there are so many side effects with these agents B. Bacteria need to have multiple different mutations before a decrease effect takes place C. Novobiocin can be used synergistically with quinolones D. Quinolones bind to the catalytic subunit B. binds to subunit A, subunit B is ATPase that provide energy for the reaction Which of these is not a mechanism for quinolone resistance? A. Mutations in DNA gyrases B. Active efflux of the drug from the cell C. Mutations in B subunit of DNA gyrase D. Modifications of lipopolysaccharides E. Qnr proteins bind to gyrase Which of these is not a mechanism for quinolone resistance? A. Mutations in DNA gyrases B. Active efflux of the drug from the cell C. Mutations in B subunit of DNA gyrase D. Modifications of lipopolysaccharides E. Qnr proteins bind to gyrase Structures Name the antibiotic class of each structure B C A D F E Name the antibiotic class of each structure B C A Beta lactam (amoxicillin) Macrolide Oxazolidinone (clarithromycin) (linezolid) D F E Streptogramin Pleuromutilin Tetracycline (dalfopristin) (retapamulin) (tigecycline) Name the antibiotic class of each structure A B C D E F  Name the antibiotic class of each structure A B C Lincosamide Monobactam (lincomycin) (aztreonam) Glycopeptide D E (vancomycin) F Streptogramin Fluoroquinolone Aminoglycoside (quinupristin) (levofloxacin) (gentamicin) Name the antibiotic A B Name the antibiotic A B Sulfonamide (sulfamethoxazole) Trimethoprim Microbiomes General Information The microbiome is comprised of what three elements? Which element is the most common? Microbiome in your gut is significantly LESS varied than other sites True or False? Name the four phyla that 93.5% of your microbiome is composed of. General Information The microbiome is comprised of what three elements? Prokaryotes, Eukaryotes, viruses Which element is the most common? Bacteria Microbiome in your gut is significantly LESS varied than other sites True or False? True Name the four phyla that 93.5% of your microbiome is composed of. Proteobacteria, actinobacteria, firmicutes, bacteriodetes What are some ways in which our microbiome help us? What do they help us produce? What are some ways in which our microbiome help us? Which of the following antibiotics do NOT cause major alterations in microbiome composition? A. B-lactam antibiotics B. Fluoroquinolones C. Tigecycline D. Clindamycin E. None of the above Fidaxomicin and rifaximin can help your gut microbiota What is one reason we want to avoid early antibiotic use in children? Which of the following are risk factors for initial Clostridium difficile infection? A. Age B. Hospitalization C. Broad Spectrum Antibiotics D. Proton Pump Inhibitors E. All of the above Which of these are modifiable? Is C. Diff likely to recur? Which of the following are risk factors for initial Clostridium difficile infection? A. Age B. Hospitalization C. Broad Spectrum Antibiotics D. Proton Pump Inhibitors E. All of the above Which of these are modifiable? PPI/Broad spectrum Is C. Diff likely to recur? Yes in ¼ of patients What are risk factors for recurrent CDI? A. Age B. Hospitalizations C. Antibiotics D. PPIs E. Liver Insufficiency F. Renal Insufficiency Why does C. diff recur? What are risk factors for recurrent CDI? A. Age B. Hospitalizations C. Antibiotics D. PPIs E. Liver Insufficiency F. Renal Insufficiency Why does C. diff recur? Spores remain, hard to fully eradicate What is the BEST treatment for recurrent C. diff? A. Donor-feces infusion following vancomycin 500 mg PO QID B. Vancomycin 500 mg PO QID C. Vancomycin 500 mg PO QID + bowel lavage D. Loperamide 4 mg PO + Loperamide 2 mg PO after each stool What is the BEST treatment for recurrent C. diff? A. Donor-feces infusion following vancomycin 500 mg PO QID B. Vancomycin 500 mg PO QID C. Vancomycin 500 mg PO QID + bowel lavage D. Loperamide 4 mg PO + Loperamide 2 mg PO after each stool Which setting below would not require an IND for a FMT? A. A 50 year-old-woman with ulcerative colitis B. A 20 year-old woman with recurrent C. diff C. A 60 year-old man colonized with MRSA D. A 45 year-old man with Crohn’s disease Which setting below would not require an IND for a FMT? A. A 50 year-old-woman with ulcerative colitis B. A 20 year-old woman with recurrent C. diff C. A 60 year-old man colonized with MRSA D. A 45 year-old man with Crohn’s disease Only FDA approved indication What is the difference between a probiotic and a prebiotic? What is the recommended dose of a probiotic post antibiotic? What are some adverse effects of probiotics? What is the difference between a probiotic and a prebiotic? Probiotic: bacteria, prebiotic: carbohydrates, food for your microbiome What is the recommended dose of a probiotic post antibiotic? 10-15 billion units per day What are some adverse effects of probiotics? GI upset Which of the following probiotic: metabolite pairs are correct? A. Bifidobacterium: Secondary bile acids B. Lactobacillus: Lactic acid C. Lactobacillus: Secondary bile acids D. Bifidobacterium: Acetic acid E. Bifidobacterium: lactic acid Which of the following probiotic: metabolite pairs are correct? A. Bifidobacterium: Secondary bile acids B. Lactobacillus: Lactic acid C. Lactobacillus: Secondary bile acids D. Bifidobacterium: Acetic acid E. Bifidobacterium: lactic acid