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Therapeutics > 4/13/13 > Flashcards

4/13/13 Flashcards

1st midterm

1
Q

Spectrum of Amoxicillin?

A

G(+) Streptococci, Enterococcus NOT S. aureus Very little G(-) coverage, no “below the diaphragm anaerobic activity”

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2
Q

Amoxicillin is drug of choice for which diseases?

A

AOM, ABS, prophylaxis of endocarditis before

dental, esophageal, and upper respiratory procedures

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3
Q

What type of killing does Amoxicillin exhibit?

A

Time-dependent killing

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4
Q

What is the MOA for Augmentin?

A

Amox: binds to penicillin binding proteins (PBPs) to
inhibit protein synthesis (bactericidal)
Clavulanic acid: inhibits β-lactamases

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5
Q

What is the spectrum of Augmentin?

A

Gram + (S. aureus, Enterococcus, streptococci)
enteric gram -, H.flu, M.cat
anaerobes below the diaphragm
Very similar to amp/sulbactam in activity

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6
Q

Augmentin is the drug of choice for which diseases?

A

Refractory otitis media, acute/severe bacterial sinusitis,

dog/cat bites, aspiration CAP

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7
Q

What is the spectrum of activity for Ampicillin?

A

Alone: covers streptococci and Enterococcus, but not
S. aureus
Gm- is ok for a few organisms, but watch out for
resistance. No Pseudomonas coverage.
Anaerobe coverage is poor because of β-lactamases
below the diaphragm
With sulbactam: modest Gm- improvement, but much
better gm+ (including S. aureus) and anaerobe
improvement

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8
Q

Ampicillin is the drug of choice for which diseases?

A

Meningitis (for Listeria monocytogenes)
Gastroenteritis (for Listeria monocytogenes)
Complicated UTI/catheters (alternative choice)
Pneumonia (not reliable for H. influenzae)

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9
Q

What is the spectrum of coverage for AMP/Sulbactam?

A

G+: streptococci, S. aureus, Enterococcus
G-: E. coli, Klebsiella, Proteus, H. influenzae
Anaerobes: good for below-diaphragm
The sulbactam improves the S. aureus and anaerobic
coverage of ampicillin, but only modestly improves
G- coverage

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10
Q

AMP/Sulbactam is the drug of choice for which diseases?

A

Intra-abdominal infections
With advanced macrolide (azithromycin) for CAP
treated on inpatient basis, non ICU (especially if
aspiration pneumonia is a concern)

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11
Q

What is the spectrum of Azithromycin?

A

Gram pos: S. pneumoniae (lots of resistance, though),
other streptococci; not a good staph drug (no MRSA)
Gram neg: H. influenzae, M. catarrhalis (not really a
good Gram-negative drug)
Atypicals (Legionella, Mycoplasma, Chlamydia): good
coverage
No useful anaerobic activity below diaphragm

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12
Q

Azithromycin is the drug of choice for which diseases?

A

Penicillin allergic AOM, CAP w/ no previous antibiotics,

Chlamydia STD

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13
Q

What type of killing does Azithromycin exhibit?

A

AUC/MIC correlates best with activity

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14
Q

What is the spectrum of activity for Aztreonam?

A

Gram (-) including Pseudomonas; no G+, no

anaerobes. Not a drug that is commonly used.

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15
Q

Aztreonam is the drug of choice for which diseases?

A

Useful in patients with a history of severe allergy to
penicillin (extremely low rate of cross-allergenicity).
Used with metronidazole in secondary peritonitis.

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16
Q

What is the spectrum of activity for Cefazolin?

A

(1st gen Ceph) Mainly gram +, a few enteric GNRs. No anaerobes
below the diaphragm.

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17
Q

Cefazolin is the drug of choice for which diseases?

A

Surgical prophylaxis, occasional skin infections.

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18
Q

What is the spectrum of activity for Cefdinir?

A

Gram (+) cocci like Strep. Might work for S. aureus
(not MRSA). Like all cephalosporins it is ineffective
for Enterococcus

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19
Q

Cefdinir is the drug of choice for which diseases?

A

Some pediatricians favor cefdinir for AOM because of

its relatively pleasant taste

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20
Q

What is the spectrum of activity for Cefepime?

A 
(4th gen ceph) Summary: Best of ceftriaxone + best of ceftazidime 
• Gm+ 
• Gm- 
• lacks anaerobes 
• Pseudomonas 
• β lactamase stable
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21
Q

Cefepime is the drug of choice for which diseases?

A

ICU monotherapy, maybe better than imipenem
because it lacks anaerobe coverage
• In combination with ciprofloxacin for ICU
treatment of CAP, 1-2 g IV q 12h x 10 days

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22
Q

What is the spectrum of activity for Cefotaxime?

A

(3rd gen ceph) Gm+
• Gm- (bacilli), but not Pseudomonas
• No below diaphragm anaerobes

23
Q

What is the spectrum of coverage for Cefpodoxime?

A

(3rd gen ceph) Some Gram + and Gram – bacteria (stable against β-
lactamases)
NOT: MRSA, Enterococcus, Pseudomonas,
Enterobacter

24
Q

Cefpodoxime is the drug of choice for which diseases?

A

Can be used in AOM if recent antibiotic use

Can be used in ABS if recent antibiotic use

25
Q

What is the spectrum of activity of Ceftazidime?

A

Gm+: limited; don’t trust for these
Gm-: Pseudomonas, most Enterobacteriaceae
Anaerobes: not useful for below-the-diaphragm

26
Q

Ceftazidime is the drug of choice for which diseases?

A
  1. Pseudomonas pneumonia in CF patients
  2. Other diseases due to Gram-negative bacteria: lifethreatening, susceptible Gram-negative organisms
    including Pseudomonas and Enterobacteriaceae
  3. Gram-negative osteomyelitis, especially due to
    Pseudomonas
  4. Hospital acquired peritonitis (in combination with
    an antianaerobic drug)
  5. Meningitis due to Pseudomonas
  6. Nosocomially-acquired UTI
27
Q

What is the spectrum of activity for Ceftriaxone?

A

Gram – (no Pseudomonas), Gram +, no below

diaphragm anaerobes

28
Q

Ceftriaxone is the drug of choice for which diseases?

A

CAP, inpatient, when Pseudomonas not an issue;
bacterial meningitis for 1 mo-50 yrs; necrotizing
fasciitis; NVE caused by HACEK group, gonorrhea
(urethral, cervical, rectal, pharyngeal, and DGI)

29
Q

What is the spectrum of activity for Cephalexin?

A

Better Gm + than Gm -.
Gm+: S. aureus (not MRSA); S. pneumoniae
Gm-: E.coli; Klebsiella sp; Proteus mirabilis
Anaerobic activity: not good

30
Q

Cephalexin is the drug of choice for which diseases?

A

Skin infections caused by Gm + organisms

31
Q

What is the spectrum of activity for Cipro?

A

Gram-, limited Gram +, no anaerobic coverage

32
Q

Cipro is the drug of choice for which diseases?

A

Acute uncomplicated cystitis (when TMP/SMX
resistance ~20% and for elderly patients), acute
uncomplicated pyelonephritis

33
Q

What is the spectrum of activity for Clarithromycin?

A

Gm+: Group A,B,C, and G streptococci; S.
pneumoniae; MSSA
Gm-: M. catarrhalis, H. influenzae
Atypicals: Mycoplasma, Chlamydophila, Legionella
No usable antianaerobic activity

34
Q

Clarithromycin is the drug of choice for which diseases?

A

Acute exacerbation of chronic bronchitis
Acute otitis media (alternative)
Community acquired pneumonia (alternative in
certain patients)
Maxillary sinusitis, acute (alternative)
Tonsillitis/pharyngitis
H. pylori

35
Q

What is the spectrum of activity for Clindamycin?

A

Anaerobes (B. fragilis group). Gm (+) cocci [including
streptococci and community-associated-MRSA]. No
aerobic G- activity

36
Q

Clindamycin is the drug of choice for which diseases?

A

Necrotizing faciitis [in combination with a β-lactam –
ceftriaxone or Pen G if GABS]. Also a popular choice
for a lung abscess

37
Q

What is the spectrum of activity for Colistin?

A

Many Gram-negative bacilli including P. aeruginosa
and Acinetobacter. However, Gram-positive
organisms, anaerobes, and a few common Gramnegatives are resistant.

38
Q

Colistin is the drug of choice for which diseases?

A

None. Useful for serious infections caused by Gramnegative bacilli resistant to everything else. Used in
inhaled form in patients with cystic fibrosis

39
Q

What is the spectrum of activity for Daptomycin?

A

Vancomycin-like spectrum (includes VRE,
MRSA,GISA, PRSP). No useful G- activity, no
anaerobic coverage.

40
Q

Daptomycin is the drug of choice for which diseases?

A

Approved for skin infections, but not likely to be a big
use for this drug,
Good use: endocarditis due to VRE
Also an for endocarditis due to MRSA and non-MRSA
S. aureus

41
Q

What is the spectrum of activity for Doxycycline?

A

Gram (+) and Gram (-)
(resistance is a problem with tetracyclines)
Atypical pathogens (for CAP)

42
Q

Doxycycline is the drug of choice in which diseases?

A

Possible for CAP (healthy, no recent antibiotics)

Possible for cat bite in penicillin-allergic patient

43
Q

What is the spectrum of activity for Metronidazole?

A

Anaerobes, protozoa, H. pylori. No activity against

aerobic bacteria.

44
Q

Metronidazole is the drug of choice for which diseases?

A

Trichomoniasis, C. difficile colitis, bacterial vaginosis,

anaerobic infections

45
Q

What is the spectrum of activity for Moxifloxacin?

A

Excellent gram-positive coverage
Not as great gram-negative coverage
Anaerobe coverage is good (unproven though)

46
Q

Moxifloxacin is the drug of choice for which diseases?

A

Can be used in ABS if recent antibiotic use

CAP patients with co-morbid conditions

47
Q

What is the spectrum of activity for Penicillin G?

A

Gram +: good for Streptococcus pyogenes (GABS) but
not active against Staphylococcus (neither MSSA nor
MRSA). PNSP prevalence about 40% in the US.
Gram -: useful for nonpenicillinase-producing species
of Neisseria
Usually effective for above-diaphragm anaerobes but
not for below-diaphragm anaerobes

48
Q

Penicillin G is the drug of choice for which diseases?

A

Acute pharyngitis
ARF prophylaxis
Syphilis, neurosyphilis

49
Q

What is the spectrum of activity of Penicillin VK?

A

Gram +: good for Streptococcus pyogenes (GABS) but
not active against Staphylococcus (neither MSSA nor
MRSA)

50
Q

Penicillin VK is the drug of choice for which disease?

A

Acute pharyngitis

51
Q

What is the spectrum of coverage for SMX/TMP?

A

Gm+: good for CA-MRSA, but usually does not work
for PNSP and does not cover Enterococcus, S.
epidermidis, or GABS
Gm-: generally effective for enteric GNR, H. influenzae;
does not cover Pseudomonas
Anaerobes: inactive

52
Q

SMX/TMP is the drug of choice for which diseases?

A

UTI (unless E. coli resistance is >20%)
SBP prophylaxis
PCP in AIDS patients

53
Q

What is the spectrum of activity for Vancomycin?

A

Gm+: active against most genera (should be combined
with an aminoglycoside to treat E. faecalis)
No Gm- activity
Anaerobic activity: C. difficile (oral only)

54
Q

Vancomycin is the drug of choice for which diseases?

A

MRSA infections
Bacterial meningitis (combined with ceftriaxone)
Vascular catheter infections due to S. epidermidis
Endocarditis (second line)
Antibiotic-associated diarrhea (second line)

Therapeutics (6 decks)

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