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Year 3 - Clinical > 1 - Antimicrobial Pharmacotherapy > Flashcards

1 - Antimicrobial Pharmacotherapy Flashcards

1
Q

Where and in what age groups are the majority of antibiotics used?

A
  • Community

- Very young and very old (likely due to immune status)

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2
Q

When are antimicrobials commonly recommended for those aged 9 years and younger?

A
  • Disease of the ear (otitis media)

- URTI

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3
Q

When are antimicrobials commonly recommended for those aged 10-19 years?

A

URTI

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4
Q

When are antimicrobials commonly recommended for those aged 60 years and older?

A
  • Lower UTI
  • Acute bronchitis
  • Skin and soft tissue infection
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5
Q

What are the most common antimicrobials used in the community setting and for which conditions?

A
  • Amoxicillin; diseases of the ear
  • Azithromycin / clarithromycin; acute bronchitis
  • Cephalexin; SSTI
  • Ciprofloxacin and nitrofurantoin; lower UTI
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6
Q

Amoxicillin and ampicillin class and coverage

A
  • Extended spectrum penicillin
  • Gram neg - neisseria and treponema pallidum (like penicillin); also E. coli, proteus, and H. influenzae
  • Gram pos - streptococcus, enterococcus, listeria
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7
Q

Azithromycin and clarithromycin class, function, and coverage

A
  • Azithromycin = azalide
  • Clarithromycin = macrolide
  • Function = inhibit s30S ribosome (bacteriostatic)
  • Gram pos - variable streptococcus (not PRSP), variable staph aureus (not MRSA)
  • Gram neg - H. influenzae
  • Atypicals - mycoplasma, legionella, chlamydia
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8
Q

Ciprofloxacin class, function, and coverage

A
  • 2nd gen fluoroquinolone
  • Inhibits gyrase, topoisomerase in DNA synthesis (bactericidal)
  • Gram neg = E. coli, klebsiella, citrobacter, pseudomonas, enterobacter, serratia
  • Atypicals = mycoplasma, legionella, chlamydia
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9
Q

What is important to remember about ciprofloxacin?

A

If used against gram pos, microorganism will acquire resistance

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10
Q

Cephalexin and cefazolin class, function, and coverage

A
  • 1st gen cephalosporin
  • Inhibit cell wall synthesis (bactericidal)
  • Gram pos = streptococcus, staph aureus (not MRSA), not enterococcus
  • Gram neg = proteus mirabilis, E. coli, Klebsiella
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11
Q

Nitrofurantoin class, function, and coverage

A
  • Nitrofuran
  • Inhibits ribosome, DNA through intracellular reduction to active metabolites
  • E. coli, E. faecalies, staphylococcus (including S. saprophiticus)
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12
Q

What are the most common antimicrobials in the hospital setting?

A
  • Cefazolin
  • Ciprofloxacin
  • Piperacillin-tazobactam
  • Vancomycin
  • Ceftriaxone
  • Metronidazole
  • Levofloxacin
  • Cloxacillin
  • TMP/SMX
  • Ampicillin
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13
Q

Piperacillin-tazobactam class and coverage

A
  • Extended spectrum penicillin and beta-lactamase inhibitor
  • Gram neg - neisseria and treponema pallidum (like penicillin); also E. coli, proteus, and H. influenzae (like amoxicillin); staph aureus (not MRSA)
  • Gram pos - streptococcus, enterococcus, listeria (like amoxicillin); also citrobacter, acinetobacter, pseudomonas, enterobacter, serratia, beta-lactamases (not ESBLs)
  • Anaerobes / bacteroides
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14
Q

Vancomycin class, function, and coverage

A
  • Glycopeptide
  • Inhibits cell wall synthesis (bactericidal)
  • Gram pos = streptococcus (including PRSP), staph aureus (including MRSA), CoNS, enterococcus (not VRE)
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15
Q

Ceftriaxone class and coverage

A
  • 3rd gen cephalosporin
  • Gram pos = strep, staph aureus (not MRSA), not enterococcus
  • Gram neg = proteus mirabilis, E. coli, Klebsiella
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16
Q

What does ceftriaxone have good coverage against?

A
  • Strep pneumoniae

- Serratia (gram neg), not ESBLs

17
Q

Metronidazole class, function, and coverage

A
  • Nitroimidazole
  • Inhibits ribosome, DNA via intracellular active metabolites (bactericidal)
  • Anaerobes
18
Q

Levofloxacin class and coverage

A
  • 3rd gen fluoroquinolone

- Increased strep pneumoniae compared to ciprofloxacin (2nd gen fluoroquinolone)

19
Q

Cloxacillin class and coverage

A
  • Penicillinase-stable penicillin

- Gram pos = streptococcus and staph aureus (not MRSA)

20
Q

Trimethoprim/ sulfamethoxazole class, function, and coverage

A
  • Sulphonamide
  • Inhibits dihydrofolate reductase and dihydropteroate synthetase
  • Gram pos = variable streptococcus, staph aureus (including MRSA)
  • Gram neg = E. coli, H. influenzae
  • Pneumocystitis
21
Q

Occasional adverse effects of azithromycin

A
  • GI disturbance
  • Headache
  • Dizziness
  • Vaginitis
22
Q

Occasional adverse effects of carbapenems

A
  • Phlebitis (inflammation of a vein)
  • Pain at injection site
  • Fever
  • Urticaria
  • Rash, pruritus
  • GI disturbance
  • Transient hypotension during IV infusion
23
Q

Common adverse effects of cephalosporins

A
  • Thrombophlebitis w/ IV use
  • Serum-sickness-like reaction w/ prolonged parenteral admin
  • Moderate to severe diarrhea
24
Q

Occasional adverse effects of clarithromycin

A
  • GI disturbance
  • Abnormal taste
  • Headache
  • Dizziness
  • QT prolongation
25
Q

Common adverse effects of clindamycin

A
  • Diarrhea

- Hypersensitivity reactions

26
Q

Occasional adverse effects of daptomycin

A
  • GI disturbance
  • Rash
  • Injection site reaction
  • Fever
  • Headache, dizziness
  • Insomnia
27
Q

Occasional adverse effects of fluoroquinolones

A
  • GI disturbance
  • Dizziness
  • Tremors
  • Oral/vaginal candida infections
  • Neutropenia, leukopenia
  • Hyper and hypoglycemia
  • Increased serum creatinine
  • Photosensitivity reactions
  • QT prolongation
  • CDI
28
Q

What is 1 common and 1 occasional adverse effect of fosfomycin

A
  • Common = diarrhea

- Occasional = vaginitis

29
Q

Common adverse effects of linezolid

A
  • GI disturbance
  • Thrombocytopenia
  • Risk greater w/ tx for > 10 days
30
Q

Common adverse effects of nitrofurantoin

A
  • GI disturbance

- Allergic reactions (including pulmonary infiltrates)

31
Q

Common adverse effects of penicillins

A
  • Allergic reactions (rarely anaphylaxis)
  • Erythema multiforma or SJS
  • Rash
  • Diarrhea, N/V
32
Q

Common adverse effects of tetracyclines

A
  • GI disturbance

- Bone lesions and staining and deformity of teeth in children up to 8 y/o

33
Q

Common adverse effects of trimethoprim / sulfamethoxazole

A
  • Hypersensitivity reactions (rash, photosensitivity, fever)
  • N/V
  • Anorexia
34
Q

Common adverse effects of vancomycin

A
  • Thrombophlebitis

- Fever/chills

35
Q

Purpose of antimicrobial stewardship

A

Optimize antimicrobial use to improve pt outcomes (maximize efficacy and minimize toxicity), limit dev’t of resistance, and reduce healthcare costs

36
Q

What are the 5 key components of antimicrobial stewardship?

A

1) Limit transmission of infectious diseases
2) Avoid unnecessary antimicrobial use
3) When warranted, use antimicrobials appropriately
4) Target antimicrobials at highest risk of inappropriate use and clinically significant pathogens w/ highest risk of antimicrobial resistance (ESKAPE bacteria)
5) Target infections (URTI, asymptomatic bacteruria) and pt populations (critically ill, dialysis, immunocompromised) at highest risk of inappropriate antimicrobial use

37
Q

How can unnecessary antimicrobial use be avoided?

A
  • Educate px on appropriate use
  • Educate prescribes and other HCP’s on appropriate use
  • Develop institutional practice guidelines or clinical pathways for treating specific infections
  • Develop specific antimicrobial restriction policies
  • Monitor institutional antimicrobial use and identify potential areas for improvement
38
Q

How can you make sure antimicrobials are being used appropriately?

A
  • Select appropriate agent
  • Avoid unnecessary duplication of antimicrobial spectrae (only use 2 antimicrobials when absolutely need to)
  • Optimize dosing based on local susceptibility profiles and PK-PD principles to maximize efficacy and minimize toxicity
  • Minimize antimicrobial-related adverse effects, including CDI
  • Prevent or minimize antimicrobial-drug interactions
  • De-escalate antimicrobial spectrae when appropriate (changing from broad to narrow spectrum when infecting agent is known)
  • Step-down to oral therapy when appropriate
  • Use shortest effective duration of therapy
39
Q

What are the ESKAPE bacteria?

A
  • Enterococcus faecium
  • Staph aureus
  • Klebsiella pneumoniae
  • Acinetobacter baumanii
  • Pseudomonas aeruginosa
  • Enterobacter species

Year 3 - Clinical (30 decks)

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