Anti-infectives I Flashcards by Jenna Foushee

Penicillin G IV is also called……and used to treat what infection?

Benzathine LA for Syphilis

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PCN V PO is also called…and is used to treat what infection?

Procaine for Strep Pneumo

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A nick name for PCN in 1929 when PCN first came out was….

magic bullet

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What is the MOA of PCN?

Stops cell wall synthesis and kills bacteria (bacteriacidal)

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What is the coverage of PCN?

Gram +, limited activity against anaerobes (above the diaphragm)

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Do you take PCN with food or on empty stomach?

Empty

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What are some AEs of PCN?

take on empty stomach
have to take ATC, q6h,
diarrhea
rash

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How is PCN eliminated?

renally

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Name 4 Antistaphylococcal PCN? Which one is the DOC?

Methicillin (IV)
Oxacillin (IV)
Cloxacillin (PO)
Dicoxacillin (PO)…DOC

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What bacteria do the antistaphylococcal PCNs cover? and what is a serious infection that is most often caused by this bug?

staph aureas

cellulitis

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Name 2 aminoPCNs. What do they cover?

Ampicillin
Amoxicillin
Gram +, some anaerobes, AND some added activity against specific gram - (E. Coli, H. Flu, M. Cat)

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What infection are the aminoPCNs commonly used for?

UTIs and Otitis Media

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Which aminoPCN is more commonly used?

Amoxicillin b/c it has enhanced absorption AND you can take it with food.

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Which aminoPCN has added coverage? what does it cover?

Ampicillin

entercoccus and listeria

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How are the aminoPCNs eliminated?

renally

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What combo makes Augmentin?

Amoxicillin/clavulanic acid

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What is Augmentin’s MOA? Which bacteria does it cover specifically?

Beta-lactamase inhibitors inhibit the enzyme in bacteria that allow them to destroy Abx. They increase the spectrum of Abx.
SA, H. Flu, M. Cat

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What are the 4 cautions of PCNs?

Caution with OCP
Anaphylaxis
Drug Fever
C. Diff

What do the extended spectrum PCNs cover?

Poor gram +

Gram - coverage, including PA

What are the 2 extended spectrum PCNs?

Ticarcillin/Claculonate (Timentin)

Piperacillin/Tazobactam (Zosyn)

What other group has similar coverage to extended spectrum PCNs?

Fluoroquinolones

Name 2 First Generation Cephalosporins and their coverage.

Cefazolin
Cephalexin
Gram + (like the aminoPCNs) + klebsiella

What do the Second Generation Cephalosporins cover? what other Abx is similar?

Gram + (not as well as 1st), gram - (not as well as 3rd)

Similar to Macrolides w/o atypicals

What do the Third Generation Cephalosporins cover? Name one and describe why ED PAs may use it?

Excellent Gram -

Ceftriaxone 1g per day….all day coverage

What are the newest Ceph drugs? What do they target?

3rd Ceph-Bactam Combo products Target drug resistant Gram - strains, improved PA coverage Very limited Gram + coverage

What are 2 cautions with Cephalosporins?

1. Anaphylaxis - 5-15% cross-sensitivity to PCN | 2. C. Diff

Why might you use Carbapenams? What do they cover?

When the patient is resistant to other Abx (ID case) | BROAD SPECTRUM

Name 2 Carbapenams. What is the #1 problem with these drugs? which one is less likely to cause this?

Imipenem/Cilastatin (Primaxin) - Guerillacillin Meropenam - less likely, but $$$ Lowers Sz threshold

If someone is allergic to PCN (SOB), is it safe to give them a Carbapenam? What about a ceph?

No, 5-15% cross sensitivity with PCN and Ceph

If someone has renal failure, but is resistant to most Abx, what drug may be reasonable?

Cilastatin (Carbapenam - broad spectrum that does not cause as much nephrotoxicity

T or F: Vancomycin is a macrolide.

False

Vancomycin covers what bugs really well?

Gram + (Cadillac) | No Gram - coverage

What is an AE of Vancomycin?

nephrotoxicity - increases serum Cr

What is VRSA?

Vancomycin resistant staph aureas - scary!

T or F: Vanc is only available IV. | What infection now calls for Vanc?

F. It is available PO and that is what is used to treat C. DIff because it is very hydrophilic.

Name 3 Macrolides.

Erythomycin Clarithromycin Azithromycin (Zithromax)

What do the macrolides cover? | What other group of Abx are they similar to?

Various Gram + and Gram - AND atypicals (legionella, Mycobacterium, Chlamydia) 2nd generation ceph

A patient is allergic to PCN but has a strep pyogenes infection, what is your go to?

Macrolide --Azithromycin

Clarithromycin has improved coverage of _____ when compared to Erythromycin.

H. flu, which causes CAP

What is a possible AE of Clarithromycin?

metallic taste disturbance with the suspension

What is the half life of Azithromycin?

long, 11-14 hours | it provides 3 weeks of drug levels

Standard dose for Z-PAK? | Is it different than IV formulation?

500 mg PO Day 1, then 250mg PO x4 days | 500mg x 5 days as single agent

If an HIV patient's CD4 levels drop below 50, what should you prescribe them and why?

600mg twice per week azithromycin for MAC PPX