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Pharm Final antibiotics/fungals > Anibiotics > Flashcards

Anibiotics Flashcards

1
Q

what are some of the advantages of oral administration

A 
decreases cost
less resources, IV, pumps etc
patient preferred
reduced phlebitis
increased pt mobility
earlier discharge
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2
Q

What is the MOA for Beta-Lactams

A

Bind to pencillin binding proteins and inhibit cell wall synthesis

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3
Q

what makes up the class of beta-lactams

A

penicillins, Cephalosporins, beta-lactamase inhibitors, aztreonam

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4
Q

what are natural penicillins used for

A

treat pharyngitis, erysipelas and syphillis

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5
Q

what is the Jarisch -Herxheimer rxn

A

with treatment of spirochetal inf.
reaction due to release of large amount of toxin after bacterial killing
Fever, Chills, Myalgia

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6
Q

What are the 1st Gen cephalosproins

A

Cephalexin-oral

Cefazolin-IV

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7
Q

What are the 2nd Gen cephalosproins

A

Cefuroxime-oral

Cefoxitin-IV

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8
Q

What are the 3rd Gen cephalosproins

A

Cefpodoxime

Ceftriaxone

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9
Q

What are the 4th Gen cephalosproins

A

Cefepime

Ceftaroline

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10
Q

What makes cephalosporin activity better

A

they are less susceptible to beta-lactamases giving them broader spectrum of action compared to penicillins

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11
Q

what is the spectrum of activity for 1st Gen Cephalosporin

A

SPEcK
Staph,Strep(+)
Proteus, E. Coli, Klebsiella(-)

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12
Q

what is the spectrum of 2nd gen Cephalosproin

A

HMSPEcK
Staph, Strep(+)

Harmophilus, Morazell Catarrhalis, Proteus, E coli, Kleb (-)

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13
Q

What are 1st gen ceph used for

A

UTI, Pharyngitis, mild skin or soft tissue, and upper and lower respiratory tract

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14
Q

What does 2nd gen ceph used for

A

sinusitis, pharyngitis, otitis media, lower respiratory tract inf,
Cefuroxime- lyme

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15
Q

what does 3rd gen cover

A

Strep pneumo (+)

Enterobacteriacease, H. influenzae, M. cararhalis (-)

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16
Q

what are 3rd gen ceph used for

A

CAP, OM, URI, Meningitis, Neutropenia,

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17
Q

what do 4 gen ceph cover

A

Strep and Staph(+)

Enterobacreriaxease, H. influ, M catarhalis, Psudomonas aerug,
Bacterocides

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18
Q

what has the highest incidence of GI effects

A

cefixime

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19
Q

what has the lowest incidence of diarrhea

A

cefprozil

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20
Q

what has the highest incidence of rash

A

cefaclor

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21
Q

what is the benefit of probenicid with cephalosporins

A

increases concentration

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22
Q

what are rates of allergic reactions like with chepalosporin

A

low about 1%

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23
Q

which generation of chepalosporin have higher risk of reaction

A

1st gen

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24
Q

what is a mono bactam an what is their MOA

A

Aztreonam

bind to penicillin binding protein and inhibit cell wall synthesis which causes cell death

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25
Q 
what selectivity does Aztreonam have?
what type of infections is it good for?
What does it need dose adjustment for?
what is the cross sensitivity like for it?
what are the adverse effects like?
A

only monobactam in US
gram (-) coverage including pseudomonas, does not cover anaerobic or gram (+)
Good for resistant infections b/c it is resistant to many beta lactamases produced by gram (-) bacteria
decreased renal function
low incidence of adverse effects-diarrhea

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26
Q

What drugs are part of the carbapems

A

Imipenem/ Cilastatin
Meropenem
Doripenem
Ertapenem

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27
Q

what is the MOA for carbapenems

A

bind to penicillin binding protein and inhibit cell wall synthesis which leads to cell death

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28
Q

What bacteria are carbapenems good for

A

resistant to most beta-lactamases and the drug of choice for infection caused by ESBL

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29
Q

What do carbapenems cover

A

Staph, Strep, Listeria (+)
Gram (-)
anaerobes
Pseudomonas except ertapenem

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30
Q

what are clinical uses of carbapenems

A

UTI, lower respiratory infections, intra-abdominal and gynecological infections, skin, soft tissue, bone, and joint inf

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31
Q

what are the adverse effects of carbapenems

A

N/V, seizures-highest with imipenem with pts that have renal failure

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32
Q

what drugs are part of the glycopeptide antibiotics

A

Vancomycin, Telavancin

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33
Q

what is the MOA of glycopeptide antibiotics

A

prevents cross linking of the cell wall peptidoglycan during cell wall synthesis

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34
Q

What does Vancomycin cover

A

gram (+) only

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35
Q

what type of infections does Vancomycin cover

A

MRSA infection- sepsis, endocarditis, meningitis, skin and soft tissue infections
USED to treat C. Diff only

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36
Q

What is the dosing regimen for Vancomycin

A

dosing is variable based on body weight and renal function

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37
Q

what level should vancomycin be above to prevent resistance

A

10-20mcg/ml

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38
Q

what are the adverse Rxn of vancomycin

A

ototoxicity, nephrotoxicit, and injection site rxn

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39
Q

what increases the risk of nephrotoxicity

A

when administered with other nephrotoxic drugs

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40
Q

What drug causes red man syndrome

A

Vancomycin
infusion related reaction that is caused by the release of histamine.
may cause erythematous or urticarial reactions, flushing tachycardia, hypotension

41
Q

how do you manage red man syndrome?

A

stop infusion, wait for it to subside, then slow the infusion rate down no faster than 1gm/hr can also administer benadryl prior to infusion

42
Q

what is the black box warning with Telavancin

A

warning in pre pregnancy which may cause abnormal fetal development. Perform pregnancy test in women of child bearing age

43
Q

what type of infections are Telavacin used for

A

complicated skin and soft tissue infections.
investigated for nosocomial pneumonia
needs to be dose adjust for renal function

44
Q

what are the ADRS for Telavacin

A

Red man syndrome, infuse over 60min, nephrotoxicity, GI upset, metallic taste

45
Q

What spectrum of activity does Daptomycin have

A

similar to vancomycin but it also covers vancomycin resistant enterococci vancomycin resistant s. aureus (VRSA)

46
Q

What conditions is daptomycin used to treat

A

skin/soft tissue, bacteremia, endocarditis

47
Q

what are adverse effects of daptomycin

A

injection site reaction, fever, chills, diarrhea, N/V
muscle cramps/ weakness
must monitor CPK and discontinue drug if muscle pain and elevation of CPK>5x ULN

48
Q

What is Fosfomycin used to treat

A

oral formulation
covers Gam (+),(-)
used for UTI in women

49
Q

what is bacitracin used for

A

used topically only very nephrotoxic

50
Q

what is cycloserin used for

what are its ADR?

A

covers gram (+), (-)
mainly used to treat TB
H/A, Tremors, acute psychosis

51
Q

what is the MOA for tetracyclines

A

binds to the 30s ribosomal subunit which prevents binding of the tRNA to the mRNA ribosome complex which interferes with protein synthesis

52
Q

what is the spectrum of activity for tetracycline?

A

S. pnemo, S. pyogenes, community acquired Staph (CA-MRSA)
gram (-) ecoli, klebsiella, H influenzae
Atypical: C. pneumonae, M. neumoniae, legionella, C trachmatic, lyme

53
Q

what are the clinical uses for tetracyclines

A

Respiratory infections, MRSA, CA-MRSA

anthrax, chlamydia, lyme

54
Q

what are adverse effects of tetracycline

A

GI intolerance
Photosensitivity
Tooth discoloration and abnormal bone growth (do not use in second half of pregnancy or kids younger than 8
Vestibular tox.

55
Q

What are the special considerations of tetracyclines

A

administration must be separated from food containing aluminum, magnesium, Calcium, and iron by 12 hours
Food: Minocycline: with or without food
Tetracycline: empty stomach
Doxycycline: with food due to GI intolerance

56
Q

What does tigecycline cover

A

gram (+),(-) and anaerobes

57
Q

what is the clinical uses of Tigecycline

A 
used in complicated skin and skin structure inf. and complicated abdominal inf.
CAP
MRSA
MRSE
VRE
penicillin resistant strep pneumo
58
Q

what is the MOA for macrolides

A

bind to 50S ribosomal subunit, inhibiting bacterial protein synthesis

59
Q

what drugs belong to macrolide class

A

Fidaxomicin
Azithromycin
Clarithromycin
Erythromycin

60
Q

What is the spectrum of activity of

Azithro, Clarithromycin, Erythromycin

A

Strep (+)

H. inf, N gonnorrhoeae (-)
Atypical: Myco, Legionella, Chlamydia

61
Q

what is the spectrum of activity of Fidaxomicin

A

C. Diff

62
Q

What are the common uses for Erythromycin, Calthromycin, Azithromycin

A 
alternate for PCN allergy
CAP
Pahryngitis
OM
Azithro- Urethritis
63
Q

what are the ADR for macrolies

Erythromycin, Azithro, Clarithromycin

A 
N/V
Abdominal pain
diarrhea
renal failure
QT prolongation
64
Q

what are the ADR for fidaxomicin

A

GI hemorrhage
N/V
abdominal pain
Anemia neutropenia

65
Q

What are the food interactions

A

Azithro and Erythro take one hour before or 2 hour after a meal

66
Q

What are the drug interactions for Eryhtromycin and clarithromycin

A

inhibit CYP 450 enzyme

67
Q

what are the drug interactions for azithro

A

may increase cyclosproine and digoxin levels

68
Q

what is the MOA for clindaymycin

A

binds to 50s ribosome subunit and inhibits protein synthesis

69
Q

what is the spectrum of activity for clindamycin

A

Stap. aureus, MSSA, CA-MRSA, Strep. ssp, peptostreptococus

ananerobes, C diff, prevotella, fusobacterium

70
Q

what are the clinical uses for clindamycin

A

skin and soft tissue inf, CA-MRSA, anaerobes, aspiration PNA, dental prophylaxis in PCN pts

71
Q

what are the adverse effects of Clindamycine

A 
GI: diarrhea, nausea, dyspnea
rash
High incidence of C diff
heptao tox
back pain
72
Q

how should clindamycin be administered

A

with food to decrease GI upset and water to decrease esophageal ulceration

73
Q

what is the spectrum of activity for linezolid

A 
gram (+) only
works on staph
(methacillin susceptible and resistant)
works on staph
(vancomycin intermed and resistant)
Enterococcus faecium
74
Q

what are the common uses for linezolid

A

MRSA, Vancomycin resistant E. faecium
skin inf and soft tissue
bone/ joint inf
bacteremia

75
Q

what are some of the special considerations of linezolid

A

good pulm penetration
exhibits weak reversible inhibition of monoamine oxidase
oral form is 100% bioavailable
preferable in PVL and CA-MRSA

76
Q

what drugs are part of the aminoglycosides

A 
Gentamicin
Tobreamycin
Amikacin
Streptomycin
neomycin
kenamycin
77
Q

what is the MOA of aminoglycosides

A

inhibits 30s ribosomal subunit

78
Q

what is the spectrum of activity of Gentamicin, tobramycin, amikacin

A

staph aureus, strep, enterocc

mostly aerobic gram (-) bacilli

79
Q

what is the clinical uses of gentamicin, tobramycin, amikacin

A

rarely used alone with gram (+) organisms,
PNA, meningitis
Used with vancomycin or PCN for endocarditis

80
Q

what are the ADR for aminoglycosides

A

ototoxicity, nephrotoxocity only occur when used longer than 5 days

81
Q

what are the benefits of extended interval dosing

A 
probable reduced nephrotoxicity
decreased lab monitoring
no risk of sub-therapeutic peak level
decreased pharmacy time for prep
easier for home care
82
Q

what is the MOA of sulfonamides

A

competitive antagonist of para-aminobenzoic acid which prevents formation of folic acid

83
Q

what is the spectrum of activity for sulfonamides

A

staph, s. pneumo, bacillus anthrasis, clostridium tetani
ecoli, proteus mirabillis, H. influenza
chlamydia trachomatis

84
Q

what are the common uses of sulfonamides

A 
UTI, toxoplasmosis
1st line for MRSA
URI
HIV PNA
CA-MRSA
85
Q

what are adverse reactions with sulfonamides

A 
photosensitiviy
rash
SJS
blood dyscrasias
sulfa allergies
86
Q

what drugs make up the fluroquinolones

A 
Ciprofloxacin
Olfoxacin
Norfloaxin
Levofloxacin
Moxifloxacin
87
Q

what is the MOA of fluroquinolones

A

inhibit bacterial topoisomerase II

88
Q

what is the spectrum of activity of cipro, ofloxacin, norfloxacin

A

enterobacteriacase, H. influ, M. catarrhalis, Neisseria,

89
Q

what are the common uses of norfloxacin

A

uncomplicated UTI

90
Q

what is cipro and ofloxacin

A

complicated UTI, gasteroenteritis, prostatits, STD, skin inf

Cipro for anthrax prep

91
Q

what is the spec of coverage with

levo, moxifloxacin, gatifloxacin

A 
strep pneumo,
enterobacteriacase
H.influenzae
M. catarrhalis
Neisseria,
92
Q

what is the clinical use of levofloxacin, moxifloxacin

A

CAP,

URI infections

93
Q

what are the adverse reactions of fluroquinolones

A 
N/V
Diarrhea,
constipation
tendon rupture
photosensitivity
prolonged QT
94
Q

what does metronidazole cover

A 
protoza
anaerobes 
bacteroides
Fusobacterium
Veillonella
C. Diff
peptococcus
peptostreptococcus
95
Q

what are the uses of metronidazole

A 
intra abdominal infection
Gyn inf
pseudomembraneous colitis
C. diff
H pylori
96
Q

what are the adverse effects of metronidazole

A

dry mouth, metallic taste
anorexia abdominal pain
CNS

97
Q

what is nitrofurantoin used to treat

A

UTI

98
Q

what is nitrofurantoin spectrum of activity

A 
e coli klebsiella
staph
strep
Viridians
enterococcus
99
Q

what are some special considerations with nitrofurantoin

A

CrCl lass than 60ml
Hepatotoxicity and pulmonary toxicity
probenecid may increase serum concentration

Pharm Final antibiotics/fungals (3 decks)

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