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Pharm Test 5 > Antibiotics 1 > Flashcards

Antibiotics 1 Flashcards

0
Q

Aerobic bacteria resistant to …

A

Metronidazole

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1
Q

Anaerobes resistant to…

A

Aminoglycerides

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2
Q

Gram - bacteria not penetrated by…

A 
Standard penicillins (lipophillic) 
Vancomycin (high mw)
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3
Q

Clostridium difficile caused by..

A

Clindamycin
Cephalosporins
Fluoroquinolones

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4
Q

Treat Clostridium difficile with..

A

Metronidazole or vancomycin

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5
Q

Antibiotics that should have reduced dose in patients with decreased kidney function

A 
Aminoglycosides
Vancomycin 
Cephalosporins
Sulfonamides/trimethoprim 
Extended spectrum penicillins
Carbapenems 
Ethambutol
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6
Q

Antibiotics whose does should be reduced in patients with decreased liver function

A 
Clindamycin
Macrolides
Chloramphenicol
Tetracycline
Metronidazole
Isoniazid
Rifampin
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7
Q

Most antibiotics are what FDA pregnancy category

A

B or C

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8
Q

What two antibiotics are pregnancy category D?

A

Aminoglycosides and tetracyclines

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9
Q

Most common allergies against antibiotics

A

Beta lactate, sulfonamides, trimethoprim,erythromycin

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10
Q

Beta lactam antibiotics work by..

A
  • Bactericidal
  • Disrupts cross-linking of cell wall by irreversible inhibition of transpeptidases and other penicillin binding proteins (covalent binding)
  • most effective when bacteria is actively dividing
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11
Q

Resistance to beta lactamase

A
  • inability of lipophillic penicillins to penetrate G- membrane
  • acquired mutation of penicillin-binding proteins
  • beta lactamases-cleavage of beta lactam ring
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12
Q

Penicillin G

A

Unstable in stomach - parenteral

Gram + bugs mostly and anaerobes

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13
Q

Penicillin V

A

Oral penicillin

Gram + bacteria and anaerobes

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14
Q

Nafcillin

A

Penicillinase resistant
Anti staph
Used for PEN G resistant staph that is MSSA
No gram -

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15
Q

MRSA

A

Methicillin resistant staph aureus

Altered penicillin binding proteins

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16
Q

Amoxicillin

A
  • Aminopenicillins
  • Activity against G- due to increased penetration
  • suseptible to beta lactamases -given orally with beta lactamase inhibitor (clavulanic acid)
  • upper respiratory infections
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17
Q

Ticarcillin, piperacillin

A

Includes organisms susceptible to aminopeninicillins plus pseudomonas aeruginosa

  • given IV for serious, hospital-acquired G- infections
  • used by beta lactamases inhibitor (clavulanic acid)
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18
Q

Clavulanic acids

A
  • Beta lactamase inhibitor
  • Combined with aminopeninicillins or antipseudomonal extended spectrum (ticarcillin, piperacillin)
  • no bactericidal activity of their own,
  • works with beta lactamases, not against altered penicillin binding proteins
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19
Q

Cephalosporins

A 
Beta lactam abx
Given parenterally 
Not effective against MRSA
Grouped into 5 generation 
1)increasing G- bacteria and aerobes
2)increasing resistance to beta lactamases
3) increasing penicillin into CNS
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20
Q

Cefazolin

A

1st generation cephalosporin
Gram +, MSSA and strep
Can be given if mild penicillin allergy
Used before surgery to prevent infections

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21
Q

Cefoxitin

A

Second generation cephalosporins
More activity against G-, higher affinity against PBP
Not used often

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22
Q

Ceftriaxone

A

3rd generation cephalosporin
Good CNS penetration and Gram - coverage
Most widely used
-meningitis, (s. Pneumo, n. Meningitidis, h.flu) and gonnorhea

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23
Q

Cefepime

A

4th generation cephalosporin

Highly resistant to beta lactamases

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24
Q

Carbapenems

A

Most powerful and broad spectrum beta lactams
Highly resistant to inactivation by most beta lactamases
Used for multi drug resistant infections, anaerobic and aerobic

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25
Q

Impenem/cilastatin

A

Carbapenems -beta lactams
Given parenterally
Cilastatin prevents renal inactivation of imipenem

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26
Q

Azetreonam

A 
Monobactams
Single beta lactam ring, not fused with 2nd ring
-used w/ penicillin allergies 
Only effective against gram - aerobes 
Highly resistant against beta lactamase
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27
Q

Vancomycin

A

Glycopeptide
Prevents polymerization of cell wall precursors
Reserved for serious infections
Only effective against gram +

Given IV for systemic and dermal, oral for GI tract infections

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28
Q

Drugs for VRSA and VRE

A

Linezolid
Daptomycin
Quinupristin/dalfopristin

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29
Q

Vancomycin resistance

A

Alters D-Ala-D-Ala to D-Ala-D-lactate

Decreased binding affinity

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30
Q

Vancomycin adverse rxns

A

Ototoxic, nephrotoxic

Rapid infusion- red man syndrome

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31
Q

Fosfomycin

A

Cell wall inhibitor

Gram - UTIs

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32
Q

Bacitracin

A

Cell wall inhibitor
Inhibits bactoprenol (lipid that transfers murein monomers across inner cell membrane) bacitracin inhibits phosphorylation
-active against Gram +

Found in neosporin w/ neomycin/polymyxin B

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33
Q

Aminoglycosides

A

Gentamicin, amikacin, streptomycin, neomycin

Highly polar cations - attracted to aerobic Gram (-) drugs
Concentration dependent
Binds to 30S - misreading of mRNA = nonsense codons

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34
Q

Aminoglycoside adverse rxns

A 
Ototoxicity-irreversible
     Elevated trough levels impede egress out of inner ear cells
     Tinnitus is warning sign
     Prolonged exposure worse 
Nephrotoxicity -reversible
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35
Q

Tetracyclines

A

Tetracycline, doxycycline, tigecycline
Bind to 30S subunit
Orally effective, except tigecycline

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36
Q

2 classes that bind to 30s subunit

A

Aminoglycosides

Tetracyclines

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37
Q

Use of tetracyclines

A

Aerobic and anaerobic G+ and G- organisms

Rickettsial infections, chlamydia, Lyme disease, mycoplasma pneumoniae

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38
Q

Tetracyclines adverse rxns

A 
Deposition in bones and teeth
GI irritation
Renal toxicity
Superinfection -CDAD and candida
Photosensitivity 
Hepatotoxic in pregnant women
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39
Q

Macrolides

A

Erythromycin, azithromycin,

Bind to 50S subunit, inhibit translocation

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40
Q

Doxycycline

A

Tetracycline

Inhibit protein synthesis

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41
Q

Erythromycin

A

Macrolides

Inhibit protein synthesis

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42
Q

Azithromycin

A

Macrolides

Inhibit protein synthesis

43
Q

Macrolide resistance mechanisms

A

Plasma mediated methylation of 50S subunit that decreases binding affinity
Efflux transporters

44
Q

Macrolide uses

A

Substitute for pen-sensitive patients
Atypical pneumoniae
Pertussis, diphtheria, chlamydia

45
Q

Macrolide adverse rxns

A

Increased GI motility

Prolonged QT interval

46
Q

Clindamycin

A

Inhibits protein synthesis -binds 50S subunit
Don’t use with macrolides
Used for most anaerobic bacteria and G+aerobes
Group A strep and gas gangrene

47
Q

Clindamycin adverse rxns

A

C. Diff associated diarrhea

48
Q

Chloramphenicol

A

Inhibits protein synthesis - 50S subunit
Broad spectrum, not used much in US
Only used form life-threatening bacterial meningitis

49
Q

Chloramphenicol adverse rxns

A

Gray baby syndrome-drug accumulates in nursing babies due to insufficient liver metabolism and renal function

Bone marrow suppression

Aplastic anemia

50
Q

Linezolid

A

Binds to site on 23S rRNA of the 50s subunit
MDR against gram + pathogens -VRE and MRSA

Reversible myelosupression
Interacts with MAOI and SSRI

51
Q

Quinupristin-Dalfopristin

A

Bactericidal when combined
Inhibit protein synthesis
Inhibits peptidyl transferase center of 23S rRNA/same site as macrolides

Gram + organisms
Serious infections caused by VRE

52
Q

Fluoroquinolones

A

Nucleic acid synthesis inhibitor

Ciprofloxacin

53
Q

Ciprofloxacin

A

Fluoroquinolone - inhibits Nucleic acid synthesis

Inhibits topoisomerase II enzymes (DNA gyrase or topoisomerase IV)

54
Q

Inhibit cell wall synthesis - inhibit transpeptidation

A

Penicillins
Cephalosporin
Carbapenems

55
Q

Inhibit cell wall synthesis-inhibition of murein precursor synthesis

A

Fosfomycin
Glycopeptides
Bacitracin

56
Q

Inhibit cell wall synthesis- inhibit mycolic acid synthesis

A

Isoniazid
Ethambutol
Pyrazinamide

57
Q

Inhibit protein synthesis - binds to 30S subunit

A

Aminoglycosides

Tetracyclines

58
Q

Inhibit protein synthesis- binds to 50S subunit

A

Macrolides
Chloramphenicol
Streptogramins
Oxazolidinones

59
Q

Inhibition of Nucleic acid synthesis - interferes with folic acid metabolism

A

Sulfonanamides

Trimethoprim

60
Q

Inhibition of Nucleic acid synthesis- inhibition of DNA gyrase

A

Fluoroquinolones

61
Q

Inhibition of Nucleic acid synthesis - inhibition of RNA polymerase

A

Rifampin

62
Q

Disruption of plasma membrane structure/function - dissolve plasma membran

A

Polymyxins

63
Q

Disruption of plasma membrane structure/function -membrane depolarization

A

Cyclic lipopeptides

64
Q

Cirpofloxacin uses

A

Widely used to tx common urogenital, respiratory, GI infections caused by Gram (-) microbes (e. Coli, k. Pneumoniae, enterobacter, salmonella, shigella…)

Prophylaxis for anthrax

65
Q

Ciprofloxacin adverse effects

A

Achilles’ tendon rupture
- avoid in children under 18
Confusion, somnolence, and visual disturbances in elderly
Some prolong QT interval
(Careful with IA and III antiarrhymic drugs)

66
Q

Metronidazole

A

Inhibits Nucleic acid synthesis
Prodrug, converted by PFOR or nitroreductase (enzymes found in bacteria)

Only works in anaerobes

Drug of choice for CDAD
Metallic taste, dark red-brown urine
Disulfiram rxn with ethanol

67
Q

Metronidazole use and adverse rxns

A

Drug of choice for CDAD

Headache, GI disturbances, metallic taste, dark red-brown urine
Disulfiram like rxn with ethanol
Inhibits metabolism of warfarin

68
Q

Sulfamethoxazole (SMX)

A

Folic acid inhibitor (Nucleic acid inhibitor)
Inhibits dihydropteroate acid
Structural analog of PABA

69
Q

Sulfamethoxazole resistance due to

A

Synthesis of sufficient PABA to overcome competitive inhibition
Mutation of dihydropteroate synthase active site
Decreased drug uptake

70
Q

Sulfamethoxazole therapeutic uses and adverse rxns

A

Broad spectrum -gram + and -
UTIs in combo with trimethoprim

Kernicterus

71
Q

Trimethoprim (TMP)

A

Folic acid inhibitor
Competitive inhibitor of dihydrofolate reductase (DHFR)
Nucleic acid inhibitor

72
Q

Trimethoprim use and adverse rxns

A

Enteric gram - and + bacilli

Suppresses bone marrow in folic acid deficient patients (pregnant, alcoholics, malnourished)
Fetal malformations

73
Q

Co-trimoxazole

A

TMP/SMX

Bactericidal combo that inhibits folate synthesis

74
Q

Co-trimoxazole (TMP/SMX) use and adverse rxns

A

UTIs
pneumocystis jirovicii pneumonia -infection in immunocompromised
Otitis media

75
Q

Daptomycin

A

Plasma membrane disrupter

In presence of calcium, inserts lipophilic tail into plasma membrane and forms an ion channel that permits efflux of k = membrane depolarization

76
Q

Daptomycin uses

A

Only gram + bacteria - MRSA and VRSA (complicated skin and endocarditis)
Inactivated by sur

77
Q

Daptomycin adverse rxn

A

Myopathy

78
Q

Colistin

A

Polymyxin- plasma membrane disrupter
Binds to negatively-charged LPS in out membrane of G- bacteria
Disrupts membrane

79
Q

Polymyxin B

A

Polymyxin- plasma membrane disrupter
Binds to negatively-charged LPS in out membrane of G- bacteria
Disrupts membrane

80
Q

Colistin sulfate

A

Topical and oral (GI) use

81
Q

Colistimethate

A

Polymyxin for parenteral use, prodrug of Colistin

82
Q

Colistimethate uses

A

Treatment of last resort for MDR G- bacterial infections

83
Q

Colistimethate, polymyxin B use

A

Topical for infections of skin, mucous membranes, eye and ear

84
Q

Isoniazid

A

Inhibits synthesis of mycolic acid
Prodrug activated by mycobacterial catalase/peroxidase (katG) to free radicals
Free radicals bind to NAD+ and NADP+ to in inhibit enzymes involved in mycolic acid synthesis

85
Q

Isoniazid metabolism

A

Inactivated in liver by acetylation

N-Acetul-INH is excreted by the kidneys

86
Q

Isoniazid adverse rxns

A
  1. Peripheral neuropathy
    From drug-induced deficiency in pyridoxine (reversed by taking vitamin B6)
  2. Hepatotoxicity
87
Q

Rifampin

A

Inhibits DNA dependent RNA polymerase
Used in combination with isoniazid for TB
Leprosy
Broad spectrum for n. Meningitidis, h. Flu, s. Aureus, legionella

88
Q

Rifampin adverse rxns

A

Hepatotoxicity
Discoloration of body fluids (red-orange)
Strong induction of CYP isoforms -increasing elimination of numerous other drugs (esp HIV drugs)

89
Q

Ethambutol

A

Disrupts assembly of mycobacterial cell wall
Inhibits arabinosyl transferase III

Used in combo for tx of TB

90
Q

Ethambutol adverse effect

A

Optic neuritis

91
Q

Pyrazinamide

A

Prodrug converted to pyrazinoic acid by mycobacterial pyrazinamidase

Used as part of combo tx for TB as a sterilizing agent

92
Q

Latent TB tx

A

Monotherapy for 6mo with INH or Rifampin

93
Q

Active TB tx

A

First 2 mo ( induction phase)
INH, rifampin, pyrazinamide
Streptomycin or ethambutol if resistant to INH

Next 4 mo (continuation phase)
Intermittent therapy with INH + rifampin

94
Q

Pen G and V are _____ spectrum and work against _____ and ______

A

Narrow spectrum, gram +, anaerobes

95
Q

Penicillinase resistant penicillin that works against MSSA

A

Nafcillin

96
Q

MRSA is due to

A

Altered PBPs

97
Q

Amoxicillin is ____ spectrum and works against ______. Used mainly for _____ infections

A

Broad, gram -, URI (h. Flu, strep pneumo, m. Cat)

98
Q

Ticarcillin and piperacillin work against gram - bacteria as well as _____. Often given IV for _______ infections

A

Psuedomonas, serious hospital acquired gram -

99
Q

____ and ____ are often used with beta-lactamase inhibitors (clavulanic acid)

A

Amoxicillin, ticarcillin/piperacillin

100
Q

T/F respository preps (benzathine) fatal if given IV?

A

True

101
Q

Penicillin allergy is from

A

Non-enzymatic breakdown of penicilloyl

102
Q

1st gen cephalosporin

A

Cefazolin

103
Q

2nd gen cephalosporin

A

Cefoxitin

104
Q

3rd gen cephalosporin

A

Ceftriaxone

105
Q

4th gen cephalosporin is _____. Used for _____

A

Cefepime, resistant infections

106
Q

Aztreonam is used for ____

A

Aerobic gram - bacteria

Pharm Test 5 (5 decks)

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