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2022 Adv Pharm Faculty Landing Page > Anti-infectives > Flashcards

Anti-infectives Flashcards

1
Q

What are common causes of drug resistance?

A
  • Overuse of broad-spectrum abx.
  • Over prescription of abx. for viral illnesses
  • Use of abx in animals that enter the food chain
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2
Q

Gram + organisms definition

A

Type of bacteria has a cytoplasmic membrane surrounded by a touch rigid mesh cell wall.

  • Ex: staph aureus, strep pneumoniae, clostridium
  • stain purple
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3
Q

Gram - organisms definition

A

Type of bacteria has a thin cell wall surrounded by a second lipid membrane.

  • Ex: E. coli, pseudomonas, H. pylori, Neisseria, gonerrhea, salmonella - stain pink
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4
Q

Obligate aerobes

A

Organism needs oxygen to survive

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5
Q

Obligate anaerobes

A

Organism is poisoned by oxygen

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6
Q

Facilitative anaerobes

A

Can grow with or without oxygen because they can metabolize aerobically or anaerobically.

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7
Q

Bacteriostatic

A

Antibiotic which stops growth of bacteria but does not kill bacteria

Typically requires a higher concentration

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8
Q

Bactericidal

A

Antibiotic which kills bacteria

  • important to use this type in patients that are immunocompromised
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9
Q

What are mechanisms of action for antibiotics?

A
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10
Q

Important factors to keep in mind when prescribing antibiotics:

A
  • immune system function
  • renal and hepatic function
  • Age
  • Pregnancy/lactation
  • Risk for multi-drug-resistance organisms
  • Patient adherence: lowest frequency for the shortest duration - cost effective
  • for kids: taste good and most concentrated dose
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11
Q

Name common gram + organisms and where the common infections they cause

A

•Staphylococcus aureus

-Commonly causes skin infections

–Can also cause endocarditis, sepsis, osteomyelitis, pneumonia

•Streptococcus

–Pyogenes (pharyngitis [GAS], impetigo, cellulitis)

–Pneumoniae (pneumonia, meningitis, sepsis)

–Agalactiae: meningitis, vaginitis [GBS], UTI, endocarditis, skin infection

•Enterococcus

–Anaerobic

–Can cause UTI, prostatitis, intra-abdominal infections, cellulitis, endocarditis

•Bacilli

–Lactobacilli -present in the mouth, vagina

–C. difficile

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12
Q

Name common gram negative organisms and the infectiosn they cause

A

•Escherichia coli

–Found in the intestines of humans and animals

–Responsible for food-borne illness and UTI

–Can also cause cholecystitis, traveler’s diarrhea and sepsis

•Pseudomonas aeruginosa

–Most common in hospitalized patients

–Can cause otitis externa, Pneumonia, wound infection, UTI, sepsis

•Klebsiella pneumoniae

–Colonizes the human mouth and gut

–Commonly causes Pnuemonia, UTI, sepsis

  • Neisseria gonorrhoeae
  • Haemophilus influenzae

–Pneumonia bronchitis, otitis media, cellulitis, infectious arthritis

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13
Q

What is the MOA of the penicillins?

A

Inhibit the biosynthesis of peptidoglycan bacterial cell wall (weakens cell wall)

-Bactericidal

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14
Q

Penicillin G Benzathine is active against what type of organisms?

A

Narrow spectrum antibiotic

  • gram + mostly: S. pneumoniae, group A strep
  • Pen G (IV) best for syphilis infection (T. pallidum)
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15
Q

Penicillin V is active against what type of organisms?

A

Narrow spectrum antibiotic

  • best for group A beta-hemolytic strep
  • strep throat/pharyngitis
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16
Q

What is Clavulanic acid?

A

A compound that inhibitis beta lactamase (made by bacteria to inactivate penicillin).

Used in Augmentin (amoxicillin/clavulanic acid) to increase spectrum of susecptible bacteria.

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17
Q

Amoxicillin and Augmentin (Amox/Clavulanic Acid) are active against what type of organisms?

A

More broad spectrum - Same gram + organisms as Pen V/Pen G but also some activity against gram - organisms

Amoxicillin - 1st line for AOM and sinusitis

Augmentin - 1st line fx for bites, UTI in pregnancy

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18
Q

Adverse drug reactions of penicillins

A
  • serious allergic reaction
  • Rash
  • GI (N/V/D)
  • Fungal overgrowth/candidiasis
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19
Q

Cephalosporin MOA

A
  • Inhibit mucopeptide synthesis in the bacterial cell wall
  • Bactericidal
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20
Q

How does spectrum of activity differ between classes of cephalosporins?

A

Earlier generations have good gram + coverage and less gram - coverage

Later generations have better gram - coverage and less gram + coverage

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21
Q

Cephalosporins Adverse Drug Reactions

A
  • C. diff
  • hypersensitivity rx
  • hemolytic anemia
  • neutropenia and leukopenia
  • coagulation abnormalities
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22
Q

Cephalosporins cautions

A
  • cross reactivity with history of penicillin allergy with anaphylaxis or hypersensitivity reaction
  • safe in pregnancy/lactation and pediatrics
  • The stronger the drug (5th generation is strongest; 1st generation is weakest) - the more chance of a C. Diff infection
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23
Q

What drugs are in the glycopeptide class?

A

Vancomycin and Lipoglycopeptides

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24
Q

Vancomycin MOA and indication

A
  • Inhibits cell wall synthesis by binding to the D-A1a-D-A1a protein in the cell wall
  • Bactericidal
  • Not well absorbed orally, given IV except for C. diff
  • Stays in the GI tract
  • First line for C. diff. infection
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25
Q

Vancomycin (oral) Adverse Drug Reactions

A
  • Ototoxicity
  • Nephrotoxicity
  • Red Man Syndrome
  • Thrombocytopenia
26
Q

Tetracyclines mechanism of action and indications

A

Tetracycline and Doxycycline

  • Inhibit protein synthesis by reversibly binding to the 30S subunit of the bacterial ribosome
  • Bacteriostatic
  • Indications include mild to moderate respiratory infections, acne, Lyme disease, and chlamydia
27
Q

Tetracyclines cautions and adverse drug reactions

A
  • Preg Cat D -
  • avoid in children < 8 years old due to teeth discoloring
  • nephrotoxic
  • photosensitivity
  • hepatotoxicity
28
Q

Tetracyclines patient teaching

A

Take with a full glass of water - do not take with milk or milk products (binds to calcium)

Can cause stomach upset/esophagitis

Wear sunscreen

29
Q

Macrolides mechanism of action and indications

A

Azithromycin, Erythromycin, Clarithromycin

  • Effective against gram + and gram - organisms
  • Bacteriostatic (can be bactericidal at higher doses)
  • Inhibits RNA-dependent protein synthesis by binding to the 50S subunit

1st line CAP

1st line pertussis

1st line chlamydia

30
Q

Macrolides adverse drug reactions

A
  • potent CYP450 inhibitor
  • combination with statins may increase risk of myopathy
  • skin rash urticaria, bullous eruptions, eczema, and Steven Johnsons syndrome
  • GI distress (esp. E-mycin)
  • QT prolongation (Azithromycin)
31
Q

Lincosamides mechanism of action and indications

A

Clindamycin

  • Gram + organisms
  • inhibits protein synthesis by binding to the 50S subunit of bacterial ribosome
  • bacteriostatic
  • MRSA skin infections, dental infections, acne (topical)

High risk for C. Diff

32
Q

Clindamycin patient education

A
  • Call clinic if diarrhea occurs (high risk for C. diff infection)
33
Q

Nitroimidazoles Mechanism of Action and Example

A

Metronidazole, Tinidazole

Disrupts electron transport of anaerobic bacteria

Indications: bacterial vaginosis, trichomoniasis - more for fungal, protozoan, parasitic infections - not as much bacterial

34
Q

Nitroimidazoles Adverse Reactions

A

Seizures

Peripheral neuropathy

35
Q

Metronidazole Mechanism of Action and Indications

A

Flagyl

  • Interacts with DNA structure causing strand breakage, inhibition of protein synthesis, and cell death
  • Bacteriostatic
  • Broad spectrum (bacterial and parasitic)

Indications: C. diff, bacterial vaginosis, stool infections, trichomoniasis (think below the belt infections) - anaerobic, protozoans, fungals

36
Q

Metronidazole Adverse Drug Reactions

A
  • metallic taste
  • dark urine
  • hepatotoxicity
  • superinfections (rare)
  • disufiram like reaction with ETOH
  • Black Box Warning: possibly carcinogenic
37
Q

Metronidazole cautions/patient education

A
  • do not use in the 1st trimester of pregnancy
  • avoid alcohol during and for 2 days after tx (can cause disulfiram rx: N/V, H/A, flushing, dizziness, chest and abdominal discomfort)
38
Q

Nitrofurantoin Mechanism of Action and Indications

A
  • Multifactorial MOA
  • Bacteriostatic in low concentrations, Bactericidal in higher concentrations

May inhibit acetyl coenzymes - interferes with bacterial protein synthesis, cell wall synthesis, and aerobic energy metabolism Indications:

Indication: uncomplicated UTI (1st line), not indicated in complicated infections or pyelonephritis

39
Q

Nitrofurantoin Adverse Drug Reactions

A
  • neuropathy
  • pulmonary reactions
40
Q

Fluoroquinolones Mechanism of Action and Indications

A

Ciprofloxacin, Levofloxacin

  • Interferes with bacterial enzymes required for the synthesis of bacterial DNA
  • Breakage of DNA strands

Indications: Complicated infections

  • pyelonephritis (1st line)
  • complicated UTIs
  • CAP (3rd line)
41
Q

Fluoroquinolones cautions/CIs

A
  • Black box warning: risk of tendon rupture and tendonitis
  • risk of QT prolongation
  • seizures
  • dizziness and confusion
  • photosensitivity
  • no children < 18 (unless pyelonephritis, anthrax, allergies to other meds)
  • not for use in pregnancy and lactation
  • high risk of superinfection (C. diff and candida)
  • increasing resistance, do not use for minor uncomplicated infections
42
Q

Sulfonamides/Trimethoprim Mechanism of Action and Indications

A

Sulfonamides block folic acid synthesis

  • Trimethoprim inhibits DNA synthesis
  • UTI
  • Community acquired MRSA
  • excellent gram negative coverage and coverage of stap/strep (gram +)
43
Q

Sulfonamides/Trimethoprim Adverse Drug Reactions

A
  • Hypersensitivity reactions: rash, fever, Stevens-Johnson syndrome (more common in HIV + patients)
  • Not for use in pregnancy (anti-folate effects)
  • Avoid in pediatrics < 2 months old
  • Hyperkalemia (reduces K+ excretion)
  • Avoid concomitant administration with K+ sparing drugs (triamterene, ACE, ARB)
44
Q

MRSA skin and soft tissue infections

A

High risk in military, students, athletes, and inpatient populations

45
Q

Mupirocin

A

Used topically to treat impetigo 3x/day for 5-14 days for up to 5 lesions

Cephalexin (oral) if there are 5 or more impetigo lesions

46
Q

Oral medication options for skin lesions

A
  • give if moderate to severe impetigo (5 or more lesions), boils, perianal strep, cellulitis cephalexin, bactrim (amox/clavulanate), dicloxacillin If MRSA skin infection is suspected: CBD (cephalexin, bactrim, doxycycline)
47
Q

Carbapenums Mechanism of Action and Examples

A

Eg: Imipenem, meropenem, etrapenem, doripenem

Impair bacterial wall structure

48
Q

Carbapenem Adverse Effects

A

Diarrhea, rash, seizure

49
Q

Monobactams Mechanism of Action and Examples

A

Aztreonam

Interfers with bacterial cell wall

50
Q

Monobactram adverse effects

A

Diarrhea, rash, anaphylaxis

51
Q

Aminogylcosides Mechanism of Action and Examples

A

Gentamicin, Tobramycin, Amikacin

Inhibits bacterial DNA synthesis/replication

52
Q

Aminogylcoside adverse effects

A

Nephrotoxic, ototoxic, neuromuscular blockade

53
Q

Oxazolidinones Examples and Mechanism of Action

A

Linezolid, Tedizolid

Inhibits ribosomal proteins

54
Q

Oxazolidinones Adverse Effects

A

Bone marrow suppression

Peripheral neuropathy

Optic neuropathy

Lactic acidosis

55
Q

Lipopeptide Example and Mechanism of Action

A

Daptomycin

Accumulates in cell membrane of G+ organisms

56
Q

Daptomycin Adverse Effects

A

Thrombocytopenia

Skeletal muscle toxicity

57
Q

Polypeptides Mechanism of Action and Example

A

Colistin

Disrupts outer membrane of G- organisms

58
Q

Polypeptides Adverse Effects

A

Nephrotoxicity

Reversible neurotoxicity

59
Q

Rifamycins Mechanism of Action and Examples

A

Rifampin, rifabutin, rifaximin

Block RNA polymerase from interacting with DNA

60
Q

Rifamycins Adverse Effects

A

Discoloration of body fluids

Hepatotoxicity

Drug-drug interactions

61
Q

Antifungal (PO) Adverse Effects

A

QT prolongation

Torsades de pointes

2022 Adv Pharm Faculty Landing Page (22 decks)

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