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Pharmacology > 26 + 27: Antibiotics > Flashcards

26 + 27: Antibiotics Flashcards

1
Q

5 MOAs of antibiotics

A
  • inhibit cell wall synthesis
  • alteration of membrane permeability
  • inhibition of protein synthesis
  • inhibition of synthesis of bacterial RNA and DNA
  • interference w/ cellular metabolism
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2
Q

3 types of abx combo effects

A
  • additive (effect is doubled)
  • potentiative (multiplied effects)
  • antagonistic (if one is bacericidal and one is bacteriostatic)
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3
Q

general adverse reactions to abx

A
  • allergic reactions
  • superinfection
  • organ toxicity: ear, liver, kidney
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4
Q

structure of beta-lactam abx

A

name derived from beta-lactam ring -> essential for antibacterial activity (cell wall lysis)

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5
Q

how is resistance developed against beta-lactam abx

A

specific enzymes can disrupt ring and inactivate MOA (beta-lactamase enzyme produced by bacteria -> resistance)

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6
Q

examples of beta-lactam abx

A
  • penicillins
  • cephalosporins
  • carbapenems
  • monobactams
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7
Q

MOA of penicillins

A
  • inhibit bacterial cell wall synthesis (beta-lactam structure)
  • bacteriostatic and bactericidal effects depending on drug dose
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8
Q

types of penicillins

A
  • basic
  • broad-spectrum
  • penicillinase-resistant
  • extended-spectrum
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9
Q

uses of basic penicillins

A

narrow spectrum

  • gram (+) and a few gram (-) bacteria
  • streptococcus and Clostridium species
  • Neisseria and staphylococcus species
  • treats anthrax, tetanus, diphtheria, endocarditis, respiratory infections, and syphilis (injectable)
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10
Q

example of a broad-spectrum penicillin

A

Amoxicillin

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11
Q

uses of amoxicillin

A

treat bacterial infections caused by variety of different bacteria (broad spectrum)

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12
Q

side effects/adverse effects of amoxicillin

A
  • hypersensitivity
  • anaphylaxis
  • superinfection (ex. yeast infections)
  • tongue discoloration and stomatitis
  • GI distress
  • C diff associated diarrhea
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13
Q

black box warning for penicillin G (broad-spectrum penicillin)

A

inadvertent IV administration of penicillin G benzathine can cause cardiopulmonary arrest and death

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14
Q

MOA of beta-lactamase inhibitors

A

inhibit bacterial beta-lactamases extending antimicrobial spectrum

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15
Q

what are beta-lactamase inhibitors combined with

A
  • penicillinase-sensitive penicillin

- piperacillin tazobactam, ampicillin sulbactam (parentral), amoxicillin clavulanate (oral)

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16
Q

characteristics of cephalosporins

A
  • beta-lactam structure
  • derived from fungus
  • 5 groups (first, second, third, fourth, and fifth generation)
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17
Q

uses of cephalosporins

A
  • broad-spectrum antibiotic w/ activity against gram (+) and gram (-) bacteria
  • more activity against gram (-) compared w/ penicillins
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18
Q

describe 1st generation cephalosporins

A

effective against most gram (+) and some gram (-) bacteria

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19
Q

bacteria affected by 1st generation cephalosporins

A
  • staphylococci
  • streptococci
  • E. coli
  • Klebsiella
  • Proteus
  • Salmonella
  • Shigella
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20
Q

describe 2nd generation cephalosporins

A

effective against gram (+) and gram (-) bacteria

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21
Q

bacteria affected by 2nd generation cephalosporins

A
  • staphylococci, streptococci, E. coli, Klebsiella, Proteus, Salmonella, and Shigella (like 1st gen)
  • Haemophilus influenza
  • Enterobacter
  • Neisseria gonorrhea
  • Nesseria meningitis
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22
Q

example of 1st generation cephalosporin

A

cefalexin (useful for common skin infection and cellulitis; not effective against MRSA)

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23
Q

example of 2nd generation cephalosporin

A

Cefuroxime (useful for otitis media, sinus infection, and pneumonia)

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24
Q

describe 3rd generation cephalosporins

A
  • effective against gram (+) and gram (-) bacteria

- has increased resistance to destruction by beta-lactamases

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25
Q

bacteria affected by 3rd generation cephalosporins

A
  • staphylococci, streptococci, E. coli, Klebsiella, Proteus, Salmonella, and Shigella (like 1st and 2nd gen)
  • Haemophilus influenza, Enterobacter, Neisseria gonorrhea, and Nesseria meningitis (like 2nd gen)
  • Pseudomonas aeruginosa
  • Serratia and Acinetobacter
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26
Q

example of 3rd generation cephalosporin

A

Cefdinir (useful for otitis media, tonsillitis, and sinusitis); used a lot in children (causes red stools that are harmless)

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27
Q

describe 4th generation cephalosporins

A
  • effective against gram (+) and gram (-) bacteria

- highly resistant to destruction by beta-lactamases

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28
Q

bacteria affected by 4th generation cephalosporins

A

staphylococci, streptococci, E. coli, Klebsiella, Proteus, and psuedomonas aeruginosa

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29
Q

describe 5th generation cephalosporins

A
  • effective against gram (+) and gram (-) bacteria

- highly resistant to destruction by beta-lactamases

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30
Q

bacteria affected by 5th generation cephalosporins

A
  • staphylococci, streptococci, E. coli, Klebsiella, Proteus, and psuedomonas aeruginosa
  • MRSA
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31
Q

example of 4th generation cephalosporins

A

Cefepime (IV for bacteremia, respiratory and skin infections)

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32
Q

example of 5th generation cephalosporins

A

Ceftaroline (IV for skin and respiratory infections)

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33
Q

what type of drug is Ceftriaxone

A

3rd generation cephalosporin

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34
Q

MOA of Ceftriaxone

A

inhibit bacterial cell-wall synthesis (bactericidal) -> beta-lactam

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35
Q

uses for Ceftriaxone

A

respiratory, urinary, skin, bone, joint, and genital infections (more severe infections)

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36
Q

side effects/adverse effects to Ceftriaxone

A
  • anaphylaxis
  • superinfection
  • headache, dysgeusia (altered taste), GI distress
  • C diff associated diarrhea
  • increased bleeding and seizures
  • nephrotoxicity
  • SJS
  • elevated hepatic enzymes
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37
Q

Can cephalosporins be given to patients w/ allergic reactions to penicillins

A

yes but about 8% have cross reaction to cephalosporins too

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38
Q

administration of Ceftriaxone

A

IM or IV (not PO)

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39
Q

drug interactions w/ cephalosporins

A
  • alcohol: causes disulfiram-like reaction (N/V, flushing, dizzy, headache, and muscle cramps)
  • uricosurics (decrease excretion)
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40
Q

T/F: you want to get bacterial cultures before starting abx

A

True

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41
Q

describe macrolide abx

A
  • bacteriostatic or bactericidal dependent on drug concentration in infected tissues
  • effective against gram (+) cocci
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42
Q

what type of drug is Azithromycin

A

macrolide

43
Q

MOA of Azithromycin (Z-Pak)

A

inhibits steps of protein synthesis (binds to 50S ribosomal subunit and inhibits protein synthesis)

44
Q

uses of Azithromycin

A
  • mild to moderate respiratory
  • sinuses
  • soft tissue/skin
  • GI tract infections
  • STIs
  • conjunctivitis
  • otitis media
45
Q

side effects/adverse effects of Azithromycin

A
  • anaphylaxis
  • superinfection
  • tinnitus and ototoxicity
  • headache and seizures
  • dysgeusia, tooth discoloration, and GI distress
  • C diff associated diarrhea
  • nephrotoxicity and hepatotoxicity
  • SJS
46
Q

drug interactions w/ macrolides

A
  • levels of warfarin, theophylline and carbamazepine increase
  • erythromycin levels increase w/ fluconozole, ketoconazole, itraconozole, verapamil, diltiazem, and clarithromycin -> his fo sudden cardiac death
  • Azithromycin levels can be reduced by antacids
47
Q

what type of drug is Vancomycin

A

glycopeptide

48
Q

MOA of Vancomycin

A

inhibits cell wall synthesis

49
Q

administration of Vancomycin

A

parenteral or oral (to treat bacterial colitis)

50
Q

uses for Vancomycin

A
  • MRSA
  • substitute for PCN allergy
  • endocarditis
  • gram (+) microorganisms
  • respiratory, skin, and bone/joint infections
  • bacteremia and septicemia
  • C diff associated diarrhea
51
Q

side effects/adverse effects of Vancomycin

A
  • ototoxicity
  • anaphylaxis
  • superinfection
  • red neck or red man syndrome
  • disulfiram like reaction to alcohol
  • GI distress and peripheral edema
  • neprhotoxicity
  • C diff associated diarrhea
  • SJS
52
Q

describe red man syndrome

A
  • occurs when IV Vancomycin is given too rapidly
  • severe hypotension
  • red blotching of face, neck, chest, and extremities
53
Q

describe tetracyclines

A
  • effective against wide range of gram (+) and gram (-) microbes
  • not usually drug of choice due to resistance and toxic effects
  • Doxycycline excreted in urine and feces
  • Minocycline eliminated by liver
54
Q

what type of drug is Doxycycline

A

tetracycline

55
Q

MOA of Doxycycline

A

inhibits protein synthesis by penetrating microbial cells

56
Q

uses of Doxycycline

A
  • used for PCN allergy
  • acne
  • anthrax and plague
  • gingivitis
  • cholera
  • STIs
  • skin, urinary, and respiratory infections
57
Q

side effects/adverse effects of Doxycycline

A
  • anaphylaxis
  • superinfection
  • photosensitivity and diplopia
  • discoloration of permanent teeth (pregnant women and children - avoid)
  • stomatitis, glossitis, and GI distress
  • C diff associated diarrhea
  • ototoxicity, hepatotoxicity, and nephrotoxicity
  • pancytopenia and SJS
58
Q

interactions w/ tetracyclines

A
  • milk products
  • antacids
  • oral contraceptive
  • penicillins
  • aminoglycosides
59
Q

what type of drug is trimethoprim-sulfamethaxazole (TMP-SMZ)

A

sulfonamide

60
Q

MOA of trimethoprim-sulfamethaxazole (TMP-SMZ)

A

inhibits bacterial synthesis of protein and folic acid

61
Q

uses of trimethoprim-sulfamethaxazole (TMP-SMZ)

A
  • otitis media
  • meningitis
  • malaria
  • respiratory and urinary infections (building resistance)
  • MRSA skin infections
62
Q

side effects/adverse effects of trimethoprim-sulfamethaxazole (TMP-SMZ)

A
  • anaphylaxis
  • photosensitivity
  • GI distress and stomatitis
  • insomnia and tinnitus
  • crystalluria and renal failure
  • blood dycrasias
  • SJS
  • C diff associated diarrhea
  • hyperkalemia and Torsades de pointes
63
Q

describe aminoglycosides

A
  • widely used to treat serious gram (-) infections
  • bactericidal
  • poorly absorbed from GI (local effects only if PO)
  • well absorbed IM or IV
64
Q

describe fluoroquinolones

A
  • synthesized through addition to quinolone structure (older drugs used for UTIs)
65
Q

what type of drug is Gentamicin sulfate

A

aminoglycoside

66
Q

MOA of Gentamicin

A

inhibit bacterial protein synthesis

67
Q

uses of Gentamicin

A
  • serious respiratory, skin, urinary, bone/joint, and intraabdominal infections
  • plague
  • bacteremia/septicemia
  • endocarditis
  • meningitis and hepatic encephalopathy
68
Q

side effects/adverse effects of Gentamicin

A
  • anaphylaxis
  • superinfection
  • seizure
  • photosensitivity
  • anemia
  • stomatitis and GI distress
  • otoxicity
  • nephrotoxicity
  • C diff associated diarrhea
  • SJS
69
Q

drug interactions w/ aminoglycosides

A
  • increased action of warfarin
  • penicillins decrease effects
  • ethacrynic acid may lead to ototoxicity
70
Q

describe fluroquinolones

A
  • synthetic bactericidal active against gram (-) and gram (+)
  • well absorbed when given orally (achieves therapeutic concentrations in most body fluids)
  • metabolizes mainly in kidneys and to some extent in the liver
71
Q

what type of drug is Levofloxacin

A

fluoroquinolone

72
Q

MOA of Levofloxacin

A

interferes w/ enzyme DNA gyrase needed to synthesize bacterial DNA

73
Q

uses of Levofloxacin

A
  • anthrax
  • skin, soft tissue, bone/joint, GYN, intraabdominal, urinary and respiratory infections
  • use in uncomplicated UTI if no other tx options are available
  • not first line of treatment due to broad spectrum (prefer more specific drug)
74
Q

side effects/adverse effects of Levofloxacin

A
  • anaphylaxis
  • superinfection
  • photosensitivity
  • eye damage
  • visual disturbances
  • GI distress and dysgeusia
  • tendinitis and tendon rupture
  • C diff associated diarrhea
  • SJS
75
Q

examples of unclassified antibacterials

A
  • Chloramphenicol

- Obitoxaximab

76
Q

MOA of Chloramphenicol

A

inhibit bacterial protein synthesis, bacteriostatic

77
Q

uses of Chloramphenicol

A
  • effective against gram (+) and gram (-) bacteria

- serious infections: bacteremia/septicemia, meningitis, and typhoid fever

78
Q

side effects/adverse effects of Chloramphenicol

A
  • anaphylaxis
  • headache
  • optic neuritis
  • nephritis
  • glossitis/stomatitis
  • GI distress
  • neurotoxicity
  • anemia
  • pancytopenia
79
Q

MOA of Obitoxaximab

A

inhibits binding of protective antigen of bacterial toxin to cellular receptors preventing lethal factors of anthrax from intracellular entry

80
Q

uses of Obitoxaximab

A

treats anthrax

81
Q

side effects/adverse effect of Obitoxaximab

A
  • anaphylaxis
  • cough and headache
  • rash, pruritus and injection site reaction
82
Q

MOA of nitroimidazoles

A
  • disrupts DNA and protein synthesis in bacteria and protozoa
  • effective against H pylori, Clostridium, Giardia, Gardnerella, Prevotella, Peptococcus, and trichomonad vaginalis protozoa
83
Q

uses of nitroimidazoles

A
  • C diff associated diarrhea
  • amebiasis
  • giardiasis
  • trichomoniasis
  • bacterial vaginosis
  • acne
  • meningitis
  • GYN, skin, intraabdominal and respiratory infections
84
Q

side effects/adverse effects of nitroimidazoles

A
  • anaphylaxis
  • superinfection
  • headache, dizzy, insomnia, weakness
  • dry mouth dysgeusia and GI distress
  • tongue/tooth discoloration
  • peripheral neuropathy and seizures
  • disulfiram-like reaction
  • SJS
85
Q

example of nitroimidazoles

A

Metronidazole

86
Q

etiology of TB

A

mycobacterium tuberculosis (acid-fast bacillus)

87
Q

transmission of TB

A

person to person (airborne) by coughing, sneezing, and talking

88
Q

patients at risk of TB

A
  • immunocompromised
  • living or working in high-risk residential settings
  • injecting illegal drugs
  • health care workers w/ high-risk patients
89
Q

sxs of TB

A
  • cough, fever, night sweats
  • GI distress and weight loss
  • positive acid-fast bacilli in sputum or bloody sputum
90
Q

who is TB prophylaxis recommended for

A
  • close contact w/ active TB
  • HIV positive/immunocompromised
  • conversion from negative to positive TB test
  • latent TB infection
  • injection drug users
  • recent immigrant from high prevalence country
91
Q

drugs used for TB infection

A
  • isoniazid
  • rifampin
  • rifabutin
  • rifapentine
  • pyrazinamide
  • ethambutol
92
Q

describe the combo therapy for TB

A
  • minimum 3-5 drugs
  • initial phase lasts 2 months
  • continuation phase is 4-7 months
  • should see improvement of sxs in 2-3 weeks
93
Q

what type of therapy is used for administration of TB meds

A
  • directly observed therapy (DOT): HCP or other responsible adult observes injection of TB meds
  • mandatory for intermittent dosing schedules
  • mandatory for MDR-TB
94
Q

side effects/adverse effects of TB meds

A
  • headache, dizzy, confusion
  • GI distress
  • peripheral neuropathy
  • ocular, otic, renal, and hepatic toxicity
  • thrombocytopenia
  • respiratory depression
95
Q

side effect specific to Rifampin

A

turns body fluids orange (soft contact lens may be permanently discolored)

96
Q

side effects of pyridoxine (vitamin B6)

A
  • hyperglycemia
  • hyperkalemia
  • hypophosphatemia
  • hypocalcemia
97
Q

MOA of isoniazid (INH)

A

inhibits bacterial cell wall synthesis

98
Q

administration of isoniazid (INH)

A

PO or IM

99
Q

side effects/adverse effects of isoniazid (INH)

A
  • dry mouth, GI distress, constipation
  • blurred vision and photosensitivity
  • tinnitus
  • drowsy, dizzy, and peripheral neuropathy
  • psychotic behavior, tremors, and seizures
  • hyperglycemia
  • hepatotoxicity
  • thrombocytopenia and agranulocytosis
100
Q

MOA of rifampin (Rifadin)

A

kills mycobacteria by inhibiting synthesis of RNA -> causes production of defective nonfunctional proteins

101
Q

administration of rifampin

A

PO (good absorption)

- IV reaches peak serum concentration immediately

102
Q

uses for rifampin

A
  • TB
  • prophylaxis for people exposed to meningococcal meningitis
  • leprosy (unlabeled)
103
Q

adverse effects of rifampin

A
  • GI upset and skin rash
  • hepatotoxicity
  • ARF
  • red-orange discoloration of urine, tears, sweat, and other body fluids (harmless
104
Q

T/F: antibiotics are safe to take during pregnancy and breastfeeding

A

True

Pharmacology (22 decks)

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