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Module 201/202 > Abx > Flashcards

Abx Flashcards

1
Q

What is pharmacokinetics?

A

all of the ways a body manipulates the drug

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2
Q

What is pharmacodynamics

A

the biochemical and physiological effects of a drug and its MOA

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3
Q

What is the difference between bactericidal and a bacteriostatic antibiotic?

A

Bactericidal kills bacteria. Bacteriostatic inhibits growth of bacteria and the immune system kills infections

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4
Q

What does MIC stand for?

A

Minimum inhibitory concentration

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5
Q

What is the difference in time dependent and concentration dependent killing? Explain in terms of MIC?

A
  1. Time dependent; 2 - 4x MIC (time above MIC = killing) 2. Concentration dependent; high concentrations (often 10x MIC) to get bactericidal effect
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6
Q

With serious infections (meningitis, osteomyelitis, endocarditis, bacteria c. neutropenia) what type of abx is preferred?

A

bactericidal

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7
Q

What are 5 examples of bactericidal abx?

A

Quinolones, aminoglycosides, penicillins, cephalosporins, rifampin

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8
Q

What are 9 examples of bacteriostatic abx?

A

tetrocyclines, macrolides, clindamycin, septra, chloramphenicol, dapsone, isoniazid, vanco, linezolid

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9
Q

What are 5 examples of time dependent abx?

A

penicillin, clindamycin, linezolid, cephalosporins, macrolides

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10
Q

what are two examples of concentration dependent abx?

A

aminoglycosides, quinolones

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11
Q

Gram +ve bacteria have a thick outer wall composed of _______.

A

peptidoglycan layer

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12
Q

Gram -ve bacteria have a thin inner wall of ________ and an outer membrane composed of _____ & _______.

A

peptidoglycan, lipopolysaccharide & protein

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13
Q

What happens to gram +ve and -ve bacteria during gram staining?

A

Gram +ve purple. Gram -ve pink (accept counter stain)

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14
Q

What are 4 examples of gram +ve cocci?

A

Staphylcoccus aureus, Streptococcus, enterococcus, peptostreptococcus

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15
Q

What are 5 examples of gram +ve bacilli?

A

bacillus sp, clostidia, listeria, corynebacterium, actinomyces

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16
Q

What is an example of gram -ve cocci?

A

neisseria

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17
Q

What is an examples of gram -ve bacilli?

A

e coli, shigella, salmonella, citrobacter, klebsiella, yersinia, morganella, proteus, serratia, enterobacter

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18
Q

Which bacteria cause the majority of skin and soft tissue infections? (particularly cellulitis)

A

staphylcoccus aureus, streptococci sp

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19
Q

What is the MOA of penicillins

A

inhibit cell wall synthesis by binding to PBPs (which aid in cell wall synthesis)

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20
Q

What are two mechanisms of resistance to penicillins?

A

beta lactamases (enzymes which break down beta lactam ring), Altered PBPs

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21
Q

cell wall synthesis inhibitors are ______ (type of abx) except for ______

A

beta lactam abx, except for vanco

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22
Q

Which organisms are covered by pen G?

A

Streptococci, peptostreptococci, coynebacterium (diptheria), clostridium (except c diff), neisseria, trep pallidum, erysipelothix, actinomyces

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23
Q

What organism is rarely covered by PenG due to resistance?

A

staph

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24
Q

Ampicillin (IV) or amoxicillin (PO) covers everything Pen G covers plus what?

A

some gram -ve, enterococcal, listeria & shigella [ enterococci, h influenza, listeria, e coli, proteus, salmonella, shigella]

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25
Q

Piperacillin covers everything ampicillin covers plus what? (3)

A

Gram -ve (klebsiella, serratia, B fragilis), pseudomonas, anaerobic (enterobacter, citrobacter)

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26
Q

What is cloxacillin?

A

beta lactamase resistant penicillin

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27
Q

What does cloxacillin (beta lactamase resistant penicillin) cover?

A

strictly gram +ve. designed specifically to cover S aureus (not MRSA), no gram -ve or anaerobic.

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28
Q

What are the three most common pathogens related to UTIs?

A

E coli (58.3%), Enterococcus (11.3%), Klebsiella pneumoniae (8.5%)

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29
Q

What must you factor into your emperic tx choice for UTIs?

A

community ecoli resistance drives emperic tx (allergy to sulfa important)

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30
Q

Which meds would you use based on community ecoli resistance?

A

20% resistance to septra (Use Nitrofurantoin/quinolone)

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31
Q

What is the duration of therapy for acute and uncomplicated UTIs?

A

3 days (if unsuccessful tx for 7 - 10 days)

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32
Q

What is the duration of therapy for a pregnant pt with uncomplicated UTIs?

A

7 days (avoid septra near term to avoid kernicterus; bilirubin induced brain dysfunction)

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33
Q

what is the class of abx that ciprofloxacin, levofloxacin and moxifloxacin belong to?

A

Fluoroquinolones

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34
Q

What does ciprofloxacin cover?

A

excellent gram -ve

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35
Q

What does levofloxacin cover?

A

Cipro (gram -ve) PLUS gram +ve/ atypicals

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36
Q

What does moxifloxacin cover?

A

Levofloxacin (gram -ve, gram +ve, atypicals) PLUS anaerobic

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37
Q

What is the MOA for fluoroquinolones?

A
  1. DNA gyrase (topoisomerase II) prevents supercoiling of bacterial DNA. 2. Topoisomerase IV allows for separation of the two rings of DNA following replication. 3. Flouroquinolones inhibit both topoisomerase II & IV. (II target in gram -ve/ IV target in gram +ve)
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38
Q

What do fluoroquinolones inhibit? What organism does that target

A

inhibit topoisomerase II & IV. Target Gram -ve (II) and gram +ve (IV)

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39
Q

What med does tendinopathy occur in 1% of patients?

A

ciprofloxacin

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40
Q

What increases the risk of developing tendinopathy on ciprofloxacin?

A

DM and steroid use

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41
Q

What are indications for the use of ciprofloxacin?

A
  1. Broad spectrum (GU infections, pseudomonas resp infections) 2. Soft tissue infections (DM, infections where gram -ve or pseudomonas may be involved) 3. Gonorrhea 4. Travellers diarrhea
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42
Q

What are the indications for levofloxacin?

A

Resp infections, sinusitis, CAP, UTis, exacerbations of chronic bronchitis

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43
Q

What are the indications with moxifloxacin?

A

Resp infections, sinusitis, exacerbations of chronic bronchitis, CAP (all Levo minus UTIs)

44
Q

What ECG changes are seen with moxifloxacin?

A

QT prolongation

45
Q

Do not use moxifloxacin in those with severe ___________insufficiency?

A

hepatic insufficiency (only 20% excreted renal)

46
Q

What is the most common pathogen associated with CAP?

A

Streptococcus pneumoniae (40% of known)

47
Q

_____ to ____ % of cases of pneumonia ave an unknown cause

A

40 - 50%

48
Q

Who can be treated empirically for CAP? (which groups)

A

those with no modifying RF and those with COPD who have not been on abx or oral steroids x 3 months

49
Q

What is the empiric tx of pneumonia?

A

macrolide abx

50
Q

Those with COPD and past abx o steroid use are more likely to harbour gram _____ organisms as well as ______ organisms

A

Gram -ve, resistant pathogens

51
Q

Your first line abx for COPD c. abx or steroids in past 3 months is?

A

resp fluoroquinolones (levofloxacin, moxifloxacin)

52
Q

Second line abx for COPD c. abx or steroids in past 3 months is?

A

Beta lactam (amoxicillin/clavulanate) OR cephalosporin (2nd Gen) & macrolide

53
Q

If a patient with CAP has a suspected micro aspiration, you will need to use an Abx with ______ coverage. What is your first choice?

A

anaerobic coverage. First choice = amoxicillin/clavulanate & macrolide

54
Q

Which 4 classes of abx have decreased protein synthesis as part of their MOA?

A

Macrolides, tetracyclines, aminoglycosides, clindamycin

55
Q

What is the MOA for macrolide abx?

A

decreased protein synthesis (50s ribosomal subunit)

56
Q

What are 3 mechanisms of resistance to macrolides?

A

decreased permeability, altered ribosomal subunits, enzymatic hydrolysis

57
Q

What do macrolide abx cover?

A

broad coverage of gram +ve and -ve, atypical coverage (mycoplasma, chlamydia), mycobacterial coverage

58
Q

What do macrolides NOT cover?

A

anaerobes

59
Q

What are 3 examples of macrolide abx?

A

Erythromycin. Clarithromycin. Azithromycin

60
Q

What two macrocodes are available in daily dosing with less GI SE?

A

Clarithromycin and azithromycin

61
Q

What is the MOA for tetrocyclines?

A

binds to 30s ribosomal sub unit to inhibit protein synthesis

62
Q

What is the resistance mechanism for tetracyclines?

A

Resistance by efflux pump or by ribosomal protection

63
Q

What are the SE of tetrocyclines?

A

SE; GI upset, photosensitivity (redness in sun exposed areas), teeth/bone problems (grey, yellow, brown discolouration)

64
Q

What is the MOA of aminoglycosides

A

Interfere with protein synthesis, bind to amnoacyl site of 16s ribosomal RNA with the 30s sub unit

65
Q

What are examples of amino glycosides?

A

Gentamycin, tobramycin, amikacin, streptomycin

66
Q

When do you need to adjust amino glycoside dosing?

A

renal failure dose adjustment

67
Q

What do amino glycosides cover?

A

aerobic gram -ve bacilli (including pseudomonas), staph aureus, enterococci

68
Q

What toxicities can occur with amino glycosides?

A

tubular necrosis, renal failure, cochlear toxicity (deaf), vestibular toxicity (vertigo)

69
Q

What are some bacterial causes of meningitis?

A

Strep pneumoniae (gram+ diplococci), neisseria meningiditis (gram - diplococci), Haemophilus influenza, listeria moncytogenes (very young, very old), lyme disease, gram -ve bacilli, staphylococcal

70
Q

The first gen cephalosporins have good gram ____ coverage.

A

first gen = good gram +ve

71
Q

As you move to 2nd, 3rd, 4th gen. Cephalosporins tend to lose _____ coverage and gain ____ coverage.

A

lose +ve and gain -ve coverage

72
Q

What are two examples of first gen cephalosporins? (one IV, one PO)

A

Cefazolin (ancef) IV and Cephalexin (keflex) PO

73
Q

when are first gen cephalosporins (cefazolin, cephalexin/ ancef, keflex) typically used?

A

Gram +ve infections (strep, staph). Perioperatively

74
Q

What are examples three examples of 2nd gen cephalosporins?

A

Cefuroxime IV (oral form = cefitin), Cefaclor, Cefoxitin

75
Q

What does cefuroxime and cofactor cover (2nd gen cephalosporins)

A

gram -ve

76
Q

What does cefoxitin cover?

A

gram -ve and anaerobic

77
Q

What are three examples of non pseudomonal 3rd gen cephalosporins?

A

CefTRIAXone, CefoTAXime (IV typically used as empiric tx of bacterial meningitis), CeFIXime

78
Q

What is an example of a 3rd gen cephalospoin that has pseudomonal coverage

A

cefTAZidime

79
Q

What is an example of a 4th gen cephalosporin?

A

Cefepime

80
Q

What does cefepime (4th gen cephalosporin) cover?

A

gram -ve and pseudomonas

81
Q

What is the only cephalosprin with anaerobic coverage?

A

ceFOXitin

82
Q

which two cephalosporins have pseudomonas coverage?

A

CefTAZadime (3rd gen) Cefepime (4th gen)

83
Q

This class of abx is broad spectrum and typically used only for serious infection with are often polymicrobial

A

Carbapenems

84
Q

What are 4 examples of carbapenems?

A

Imipenem + cilastatin. Meropenum. Ertapenem, Doripenem.

85
Q

All of the carbapenems (imi+cilastatin, mero, efta, dori) cover pseudomonas except for ________

A

Ertapenem

86
Q

What else do carbapenems cover?

A

Gram +ve, Gram -ve, Anaerobes

87
Q

Seizures are a SE of _______?

A

Imipenem (seizures)

88
Q

N&V, diarrhea, headache a SE of ________?

A

Doripenem (N&V,Diarrhea, HA)

89
Q

What is the MOA of carbapenems?

A

class of beta lactams which are highly resistant to beta lactamasses

90
Q

Which abx have anaerobic coverage? (7)

A

Metronidazole (flagyl). Clindamycin. Clavulin. Piperacillin/Tazobactam. carbapenems. cefoxitin. Moxifloxacin

91
Q

What is the MOA for metronidazole

A

a nitromidazole abx which is reduced to toxic compounds that kill bacteria (bactericidal)

92
Q

What does metronidazole cover?

A

covers anaerobes and parasitic infections (C diff as well)

93
Q

What are the SE of metronidazole?

A

Seizures, peripheral neuropathy, must avoid ETOH, metallic taste in mouth

94
Q

What is the only non B-lactam abx to have its effect at the cell wall level?

A

Vancomycin

95
Q

Vancomycin only covers ______.

A

Gram +ve

96
Q

Vancomycin is not orally absorbed, so why do they make an oral form of it?

A

oral formulation to treat C Diff Colitis

97
Q

What are the clinical uses of vancomycin?

A

Gram +ve infection with severe pen allergy, MRSA and enterococcal infection (endocarditis), C Diff (oral vanco)

98
Q

What are the SE of vancomycin?

A

Ototoxicity, nephrotoxicity, allergy, redman syndrome (flushing/redness of face); rapid infusion related

99
Q

What are 8 mechanisms of abx resistance?

A
  1. enzymatic inactivation 2. decrease permeability of bacterial membranes (change in porin layers of LPS in gram -ve) 3. Anx efflux 4. Altered target sites (altered ribosomal units or PBPs) 5. Altered target enzymes 6. Protected target sites 7. Overproduction of target 8. Bypass of abx inhibition
100
Q

” The combined effects are greater than the sum of their independent activities” What word is used to describe this effect when using a combo of abx?

A

synergistic

101
Q

“The activity of the combination of 2 abx is less than the sum of each of their additive products” What is the term used to describe this?

A

antagonistic effect

102
Q

Explain why penicillin and gentamycin are used together to treat enterococcal endocarditis?

A

Pen alone typically does not work due to resistance. But pen damages the cell wall which allows more gentamycin to enter the cell to work @ the ribosomal level

103
Q

How does clindamycin work?

A

Inhibits protein synthesis (lincosamide antibiotic)

104
Q

How does resistance occur?

A

resistance altered by 50s receptor sites or by enzymatic inactivation

105
Q

What are the indications for clindamysin

A

anaerobic infections, staph or strap, pen allergic patients (gram +ve & anaerobes)

106
Q

Which abx have anti-pseudomonal properties? which is the only po med?

A

Ciprofloxacin (ONLY PO), Pipercillin/tazobactam, carbapenems, aminoglycosides, ceftazidime, cefepime

107
Q

What meds can be used in tx of MRSA?

A

Vancomycin, rifampin, trimethoprim/sulfamethoxazole, clindamycin, linezolid, daptomycin, Quinupritin -dalfopristin

Module 201/202 (5 decks)

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