ABX Flashcards
What three drugs cover VRE
Linezolid, Daptomycin, Colistin
Snoop in the LDC with VRE
What 7 abx groups cover MRSA and MSSA
5th gen Cephalosporins, Vancomycin, Daptomycin, TMP/SMX, CLindamycin, Doxycycline
MRSA (I got 5 on it, 5th gen)
VDC-mycin and doxy
TMP/SMX (just know that one)
What 8 drug groups do not cover MSSA
Penicillin, Ampicillin, Azteronam, Ciprofloxin, Azithromycin, Gent/Tobra/Amikacin, Colistin, and metronidazole
Peter And A Cat All Got To Amsterdam Chasing Money
What 9 drug groups cover Abdominal anaerobes
Ampicillin/ sulbactam, Pipercillin/ tazobactam, 2nd gen Cephalosporins, Ertapenem, Imipenem/Cilastatin, Doripenem, Meropenem, Moxifloxacin, TMP/SMX, Clindamycin, Metronidazole
What 5 drug groups cover Atypical gram negs
Moxifloxacin Ciprofloxacin Azithromycin Clindamycin Doxycycline
What do penicillins cover
Many gram postive and some gram neg
What does penicillin cover with an added B-Lactamase inhibitor
More gram pos, gram neg, and some pseudomonas
What do 1st gen Cephalosporins cover
Gram pos and neg
What is the MOA of beta Lactams
MOA: Cell wall synthesis inhibitors
Bactericidal (time dependent)
All beta lactams are renal excretion with an exception for which three
Nafcillin
Oxacillin
Dicloxacillin
(Biliary secretion)
What is the ADE of Penicillins
cross sensitivity with other B-lactams & c. dif
What is the DOC for PCN sensitive gangrene
Penicillin
What is the DOC for syphillis
Penicillin G benzathine
What are the 3 penicillins
Penicillin G, Penicillin G Benzathine, and Penicillin V
What are the three anti staph PCNs
Dicloxacillin
Oxacillin
Nafcillin
D.O.N.
Anti staph penicillins are important because they can cover..
MSSA
And do not require renal adjustment (biliary secretion)
What are the 4 aminopenicillins
Amoxicillin
Ampicillin
Amoxicillin+Clauvanic Acid (Augmentin)
Ampicillin-sulbactam (Unasyn)
What is amoxicillins drug class and use
Amino penicillin (beta lactam) (Oral)
- 1st line peds OM
- Endocarditis prophylaxis going for oral, dental or upper resp sx procedures (or clindamycin allergic).
- UTI to for pregos
- duodenal ulcer by H.Pylori
What is the role of ampicillin
Gram neg coverage beta lactam that -Combined with Aminoglycosides -Clavulanic Acid/Sulbactam/Tazobactam are B-lactamase inhibitors that prevent bacteria from being resistant to B-lactams
What is the role of Amoxicillin- Clauvanic Acid
Gram Neg coverage beta lactam
(Augmentin)
Abd. Anaerobes
- Otitis media resistant to amoxicillin
- DOC animal bite
- human bites: Early
In OM, if there is resistance to Amoxicillin , what drug combination should be used
Augmentin
Amoxicillin+Clauvanic Acid
What is the role of Ampicillin+Sulbactam
Gram neg coverage beta lactam
(Unasyn)
Abd. Anaerobes
- Human bites: Later
- HAP
- MSSA
What are the drugs to use in early versus late human bites
Early: Amoxicillin-Clavulanic Acid (Augmentin)
Late: Ampicillin-Sulbactam (Unasyn)
What in the Anti Pseudomonal PCN
Pipercillin/Tazobactam (Zosyn)
What is the role of Pipercillin/ Tazobactam
Beta lactam (often combined with aminoglycoside) -Tx of *Pseudomonas, MSSA, Abd. Anaerobes Severe infx
What are the DDI of Antistaph PCNs
Warfarin
Which cephalosporins x the BBB
3rd Gen- Ceftriaxone (Rocephin)
What are the 4 1st gen Cephalosporins
- Cephradine (Velosef)
- Cefadroxil (Duricef)
- Cephalexin (Kelflex)
- Cefazolin (Ancef)
Phrad-Fad-phal-faz
What are 1st Gen Cephalosporins used for
- Sx/wound prophylaxis,
- Abd Sx prophylaxis (+ metronidazole)
What drug should be combined with 1st gen Cephalosporins for Abd surgery prophylaxis
Metronidazole
What is the MOA of Cephalosporins
Beta Lactams Cell Wall inhibitors Bactericidal Time Dependent Renally secreted Preg Cat B
What drug group should be used for OM if the patient is allergic to PCN
2nd gen Cephlosporins
What are the 6 2nd Gen Cephalosporins
- Cefuroxime axetil
- Cefuroxime
- Cefprozil (Cefzil)
- Cefaclor(Ceclor)
- Cefoxitin (Mefoxin)
- Cefotetan (Cefotan)
Which 2nd gen cephalosporin has anaerobe coverage and is good for pre and post Abd Surgery
Cefoxitin and Cefotetan
What are the 7 3rd gen Cephalosporins
- Ceftriaxone (Rocephin)
- Ceftazidime (Fortaz)
- Cefotaxime (Claforan)
- Cefditoren pivoxil (Spectracef)
- Cefixime (Suprax)
- Ceftibutin (Cedax)
- Cefpodoxime (Vantin)
What is the cephalosporin DOC for meningitis
Ceftriaxone (rocephin)
What 3rd Gen Cephalosporin is the DOC for N. Gonorrhea
Ceftriaxone (Rocephin)
What is the ADE with 3rd Gen Ceftriaxone
Do NOT use on NEONATES,
crystals in lungs
or biliary slugging
What 3rd gen cephalosporin covers pseudomonas
Ceftrazidime (FortaZ)
3rd Gen Cephlosporins are mostly good for what three conditions
OM
Meningitis
N. Gonorrhea
What is the 4th Gen cephalosporin
Cefepime
What is the role of 4th gen cefepime
- Broadest spectrum
- ICU
- MSSA
- Pseudomonas Coverage
What is a cephalosporin that can be used in complicated UTI
4th gen Cephalosporin
Cefepime
What is the 5th gen cephalosporin
Ceftaroline (Teflaro)
What is 5th gen Ceftraroline good for
SSTI
CAP
MRSA/MSSA
Which gen of cephalosporins covers MRSA and MSSA
5th Gen
Ceftaroline
What are the combination cephalosporins that can be used to treat psuedmonas
(last line cover eagle)
1.Ceftolozane/Tazobactam(Zerbaxa) 2.Ceftazidime/Avibactam(Avycaz)
What are the 4 Carbapenems
Dorienem
Imipenem/ Cilastatin
Meropenem
Etrapenem
(DIME)
All 4 Carbapenems are good against pseudomonas except for..
Ertapenem
What are Carbapenems used for
Very broad- should not be used liberally
MSSA
Pseudomonas (Except Ertapenem)
anaerobic coverage
What is the one Monobactam
Aztreonam
What is axtreonam used for
Monobactam used for
- Pseudomonas
- No gram (+) coverage
- Can use in PCN/cephalosporin allergic PTs
Aztreonam can be used when a pt is allergic to what other ABX
PCN/cephalosporin allergic PTs
If the pt is allergic to ceftazadime what drug can you also not use
Aztreonam
What is the risk with taking Imipenam <4g/day
SZR
What are the 4 drug groups that fall under beta lactams
Penicillins
Cephalosporins
Carbapenems
Monobactams
What is the MOA of Glycopeptides and Lipoglycopeptides
MOA: cell wall synthesis inhibitor Bactericidal Time dependent Renal adjust Safe for pregnancy (B)
What drug class in Vancomycin
Glycopeptides & Lipoglycopeptides
Cell wall synth inhibitor
What is the 1st line DOC for C. Diff
Vancomycin
What is the role of Vancomycin
cell wall synthesis inhibitor Bactericidal Time dependent Renal adjust Safe for pregnancy (B)
Gram + only
MRSA/MSSA
1st line C. difficile oral only
100% remains in intestines
Does PO vancomycin need renal adjust?
Does IV?
PO no, 100 percent remains in intestines
IV yes, renally secreted
What is the MOA of Cyclic Lipopeptides
MOA: bacterial cell membrane inhibitor Bactericidal CONCENTRATION dependent Renal adjust Pregnancy: adv events not observed in animal studies
What is the MOA of Daptomycin
Cell membrane inhibitor
-cidal, concentration dependent
Renal excreted
What is the role/ use of Daptomycin
MRSA/MSSA/VRE (Covers the big three)
Only gram +
USE: Complicated SSTI, MRSA/MSSA
Bacteremia, Endocarditis, Osteomyelitis
Daptomycin can not be used to pulm infx because of what
It’s degraded by surfactant
What is Daptomycins ADE
ADV: Nephrotoxicity
-Rhabdomyolysis (MUST MONITOR CK)
What drug class does Daptomycin fall under
Cyclic Lipopeptide
What is the MOA of polymyxins
acts as detergent and damages bacterial cytoplasmic membrane
Bactericidal
Renal adjust
Nephro and Neuro toxic
What drug class does Colistimethate (Colistin) fall under
Polymixins
What is Colistimethate (Colistin) used for
Only gram –
Pseudomonas
INH (INHALED) for pulmonary infections (pneumonia with Cystic Fibrosis)
Complicated gram – infections
What is the polymixin to use in complicated gram neg infections
Colistimethate (Colistin) IV/INH
What is the ADE of Colistimethate (Colistin)
nephrotoxicity
neurotoxicity (neuromuscular blockade)
What is the rout of admin for Colistimethate (Colistin)
IV and inhaled (Pulm INfx w/ cystic fibrosis)
What is the DOC for a pulm infx with cystic fibrosis
Colistimethate (Colistin)
What is Topical Polymixin B used for
Gram (-)
USE: ear infections, bladder irrigation, ocular infections
What is the MOA of topical polymixin B
MOA: acts as detergent and damages bacterial cytoplasmic membrane
Bactericidal
What is the MOA of bacitracin
MOA: Inhibits cell wall synthesis
What is the coverage of bacitracin
Gram +
What is the MOA of neomycin
Protein synth inhibitor
What is the coverage of neomycin
Gram -
What are the three drugs that make up neosporin
Polymixin B, Bacitracin, Neomycin
What is the MOA of Tetracyclines and Glycylcyclines
MOA: Protein synthesis inhibitor
Bacteriostatic
What are the ADE of Tetracyclines & Glycylcyclines
Tissue hyperpigmentation
(major risk in children, irreversible teeth stains)
Photosensitivity
NOT SAFE FOR PREGNANCY!
Breastfeeding (pump and dump)
No children under 8 years old!
What is the 1st line Tetracycline that is used for Tick borne diseases
Doxycycline (Vibramycin)
Does Doxy need to be renal adjusted
No
What is the MOA of doxy
Protein synthesis inhibitor
-static
What is Doxy good for
MRSA
Option for Malaria prophylaxis & treatment
Option for chlamydia trachomatis
Resp tract infections (S. Pneumonia)
H.Pylori
SSTI
What are the 3 tetracyclines
Doxy
Tetracycline
Minocycline
Does Doxy cover pseudomonas
No
What are the ADE of Doxy
N/V, Tissue Hyperpigmentation (teeth) , Photosensitivity
What is the one Glycylcyclines
Tigecycline (IV)
What does Tigecycline (IV) cover
Is a Glycylcyclines (protein synth inhibitor)
- MRSA (good)
- VRE
What is Tigecycline (IV) used for
-Increases all-cause mortality and should be reserved for cases when other therapies are not suitable.
What is the dose adjustment for the gylcyline: tigecycline
-Eliminated hepatically, only adjust in severe hepatic impairment.
What is the MOA for Aminoglycosides
MOA: Protein synthesis inhibitors.
Bactericidal
Concentration dependent
Excreted unchanged renally, dose based on creatine clearance.
NOT SAFE FOR PREGNANCY (D)
Not absorbed orally/topically; route is highly relevant to site of infection (IV, INH, Topical)
What are the 5 aminoglycosides
- Gentamicin
- Tobramycin
- Amikacin
- Streptomycin
- Neomycin B
STAN-G
How are aminoglycosides used
Mono Therapy rarely used
only for complicated infections with susceptible gram (–) UTI
Combination with cell-wall inhibitors used for severe infections caused by Gram +/- pathogens (no anaerobic coverage)
Do Aminoglycosides have anaerobic coverage
No
What is the coverage of Aminoglycosides
Gram (– ) more potent
Pseudomonas
Amikacin or streptomycin > Tobramycin or Gentamicin
What is the ADE of Aminoglycosides
ADV: Nephrotoxicity (acute but reversible)
And ototoxic
Use in caution with elderly pts (5 days)
Aminoglycosides can be used with what other ABX groups to help cover pseudomonas
B-lactams, Vancomycin and Daptomycin
For the test gentamicin only covers
Pseudomonas
For the test tobramycin only covers
Pseudomonas
For the test Amikacin and Stroptomycin only cover
Pseudomonas
What is the MOA of Macrolides and Ketolides
MOA: Protein synthesis inhibitors
Bacteriostatic
Both time/concentration dependent
Atypicals
What is the ADE of macrolides and Ketolides
ADV: Acute cholestatis, hepatotoxicity
NONE ARE A GOOD CHOICE FOR INFECTIONS THAT REQUIRE BACTERIOCIDIAL ACTIVITY!
If a infx requires -cidal activity can you use Erthymoycin or Azithromycin
No they are -static
Macrolides are a good alternative agent for pts allergic to..
B-lactams
What are the three macrolides
Erythromycin
Azithromycin
Clarithromycin
All end in romycin
What is the ADE of erythromycin
causes most GI problems, used as a promotility agent.
Cardiac QT interval prolongation (pharmacy will verify with you if safe)
Acute cholestatis, hepatotoxicity
What is Azithromycin good for
Macrolide
Alternative for B-Lactam pts
Chlamydia Infections
Safe for Pregnancy
Low DDI
What is the MOA of Erythromycin, Azithromycin, and Clarithromycin
Protein synth inhibitors
-static
What is clarithromycin used for
H. Pylori/ GI ulcer
Can clarithromycin be used in pregnancy
NO
What are Ketolides good for
Have activity against strains resistant to macrolides
What is the one Ketolide
Telithromycin
What is the MOA of telithromycin
Protein synth inhibitor
-static
What is the MOA of drugs that end in -romycin
Macrolides & Ketolides
MOA: Protein synthesis inhibitors
Bacteriostatic
Both time/concentration dependent
What is the MOA of drugs that in the -damycin
Lincosamides
MOA: Protein synthesis inhibitor Safe for pregnancy (B)
Does not cross BBB.
No renal adjustment
What is the MOA of clindamycin
Lincosamides
MOA: Protein synthesis inhibitor Safe for pregnancy (B)
Does not cross BBB.
No renal adjustment
What ABX has the highest risk of causing C. Diff
Clindamycin
What is the ADE that clindamycin causes in HIV pts
Rash
What is Clindamycin used for
USE: SSTI, MRSA, MSSA, Malaria
anaerobic intra-abdominal infections associated with trauma
ORAL cavity, ACNE, Diabetics, Atypicals, Anearobes
What is the MOA of drugs that end in -pristin
Streptogramins
MOA: Conformational change
Bactericidal
What is the MOA of Quinupristin/Dalfopristin
Streptogramins
MOA: Conformational change Bactericidal
What is the ADE of Quinupristin/Dalfopristin
Hyperbillirubinemia
What is Quinupristin/Dalfopristin good for
Good MRSA/MSSA, VRE (the big three)
USE: MDR organisms, endocarditis, bacteremia, SSTI