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Pharmacology > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

What is the cellular structure of gram positive bacteria & how do the cells stain?

A

Cell walls have thick layers of peptidoglycan in gram positive bacteria
-Stain purple

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2
Q

What is the cellular structure of gram negative bacteria & how do the cells stain?

A

Thin layer of peptidoglycan in gram negative bacteria

Stain pink

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3
Q

What are the groups of bacteria that are gram positive organisms?

A
  • Staphylococcus sp.
  • Streptococcus sp.
  • Enteroccus sp.
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4
Q

What are the two types of Staphylococcus sp. organisms? Name the type of organisms & subtypes of each

A

Gram positive
• Coagulase positive: S. aureus
- methicillin|oxacillin sensitive S. aureus = MSSA
- methicillin|oxacillin sensitive S. aureus = MRSA

• coagulase negative Staphylococcus

  • methicillin sensitive S. Epidermis= MMSE
  • methicillin resistant S. Epidermis= MRSE
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5
Q

What are the types of Streptoccus sp. organisms? Name the types of each organism

A

Gram positive
Alpha hemolytic: Steptoccus pneumoniae
Beta hemolytic: group A Streptococcus sp = S.pyogenes

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6
Q

What type of organism is Enterococcus sp.? Name each type

A

Gram positive
•Enterococcus faecalis/enterococcus facium
• Vancomycin Resistant Enterococcus = VRE

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7
Q

What are the types of gram negative organisms?

A
  • Enterobacteriaciae: E.coli, klebsiella sp, Proteus sp.
  • Respiratory: H. influenza, M. catarrhalis
  • Pseudomona aeruginosa
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8
Q

What group of bacteria do bacteroides sp. belong to?

A

Anaerobes

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9
Q

What are the atypical types of bacteria?

A
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
  • Legionella pneumopniae
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10
Q

What type of organism is Escherichia coli (E. coli) & where are they found in the body?

A

Enterobacteriaciae - gram negative

• GI flora of humans & animals

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11
Q

What type of organism is Klebsiella sp. and where is it found in the body?

A

Enterobacteriaciae - gram negative
•nasopharynx
• GI flora

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12
Q

What type of organism is Proteus sp. and where are they found?

A

Enterobacteriaciae - gram negative
• soil
• GI flora
• water and sewage

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13
Q

What is the drug of choice for streptococcus organisms? What types of bacteria are they?

A

Natural Penicillin
• Gram positive
- Pneumoniae (resistance is increasing)
- Enteroccus

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14
Q

What Gram negative organisms does natural Penicillin cover?

A

• Neisseria
- gonorrhoeae ( need to use with another drug to be effective)
-Meningitidis
• Treponema palladium (syphillis)

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15
Q

What are the adverse reactions of natural Penicillin?

A
  • Hypersensitivity
  • GI symptoms: N/V/D, abd p
  • interstitial nephritis
  • Neurotoxicity
  • Hematologic toxicity
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16
Q

What is considered a true allergy to penicillin?

A

Anaphylaxis

* rash can be concerning

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17
Q

What is the most common type of aminopenicillin? What is the spectrum of activity for this drug?

A

Amoxicillin PO
• Gram positive:
-Streptococci
-Enterococcus (drug of choice)

• Gram negative:*

  • Proteus sp
  • E.coli
  • H. Influenza
  • all beta lactamase negative
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18
Q

What are the adverse reactions of aminopenicillins?

A 
Similar to natural penicillin but 10% of patients will develop non puritic, non-urticarial skin rash
• Hypersensitivity
• GI symptoms: N/V/D, abd p
• interstitial nephritis
• Neurotoxicity
• Hematologic toxicity
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19
Q

Can a patient with a true PCN allergy be prescribed Amoxicillin and why?

A

No, they will have anaphylaxis or develop a rash

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20
Q

What 3 drugs are categorized as penicillinase-resistant penicillins?

A

PO: Dicloxacillin
IV: Nafcillin, Oxacillin

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21
Q

What is the spectrum of activity of penicillinase-resistant Penicillins?

A

Gram positive organisms:
Staphylococcus sp. -MSSA/MSSE -> Drug of choice
Streptococcus sp
No gram negative or anaerobes

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22
Q

What are the adverse reactions of penicillinase-resistant penicillins?

A

Allergic reactions
Interstitial nephritis
Increased LFTs with oxacillin

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23
Q

What is a drug interaction that penicillinase-resistant Penicillins cannot be prescribed with and why?

A

Warfarin: will cause patient to bleed out

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24
Q

What two drugs are classified as anti-pseudomonal penicillins?

A

Piperacillin IV * more potent
Ticarcillin IV

  • Typically grouped w/ another drug
25
Q

What is the spectrum of activity anti-pseudomonal penicillins on gram positive organisms?

A

Streptococcal sp

Enterococcus

26
Q

What is the spectrum of activity anti-pseudomonal penicillins on gram negative organisms?

A

• Beta-lactamase negative

  • E. Coli
  • K lebsiella sp
  • Proteus sp.
  • H. influenza
  • M. Catarrhalis

Pseudomonas

27
Q

What are the adverse reactions of anti-pseudomonal PCN?

A
  • allergic reactions
  • Electrolyte abnormalities
  • interstitial nephritis
  • seizure, delirium, psychosis
  • neutropenia, thrombocytosis
28
Q

What are the most commonly used beta-lactamase inhibitors?

A

PO: Amoxicillin-Clavulanic Acid (Augmentin)
IV: Ampicillin-Sulbactam (Unasyn)
IV: Piperacillin-tazobactam (Zosyn) - anti pseudonomal

29
Q

Why are -cillin drugs combined with other drugs?

A
  1. They have little antimicrobial on their own
  2. Combination w/ beta-lactamase inhibitors protects them from deactivation of gram negative bacteria that produce beta lactamase (& gram+ Staphylococcus sp)
30
Q

What drugs are classified as monobactams?

A

IV: Aztreonam (Azactam)
Inhalation: Aztreonam (Cayston)

31
Q

What is the spectrum of activity for monobactams?

A 
Gram negative organisms only:*
•E.coli
• Klebsiella sp
• proteus sp
•H. influenza
• M. catarrhalis
• Pseudomonas
  • No gram positive & no anaerobes
32
Q

What antibiotic can safely be prescribed to patients with a penicillin allergy?

A

Aztreonam

  • only 1 beta-lactam ring that is not fused to another ring
  • Little cross-sensitivity
33
Q

What are the adverse reactions of monobactams?

A

Abnormal liver function
Phlebitis
Skin rash
Must reduce dose if pt has poor renal function

34
Q

What drugs are classified as carbapenems?

A 
IV
Etrapenem (Invanz) 
-> imipenem - cilastatin*
Meropenem (Merrem)
-> Meropenem-Vaborbactam (Vabomere)
-> Doripenem
  • imipenem is always coupled with cilastatian to protect it from metabolism by renal dehydropeptidase I
35
Q

What is the only carbapenem that covers gram + Enterococcus faecalis

A

Imipenem

36
Q 
All of the following carbapenems cover pseudomonas except:
Ertapenem (Invanz) 
Imipenem
Meropenem 
Doripenem
A

Ertapenem

37
Q

What group of organisms do all carbapenems cover?

A

Anaerobes: Bacteroides sp.

38
Q

What are the adverse reactions of carbapenems?

A 
More common:
HA, allergic rash/fever,N/V, hypotension, dizziness
Less common:
Seizures
Renal failure
Increase in LFTs
39
Q

What drug interacts with carbapenems? Which carbapenem is safe to give Rx to patient that is on the drug that it interacts with?

A

Valproic acid / Depakote
- Rx of meropenum to any elderly patient with hx of seizures
Increases LFTs

40
Q

How would you give a carbapenem to a patient with a penicillin allergy?

A
  1. First dose-low in a controlled setting
  2. Slowly titrate up and monitor patient
    Or administer full dose in a supervised setting (inpatient or ER)
41
Q

What drug protects against Carbapenemases?

A

Meropenum + Vaborbactam = Vabomere
Only administered IV

  • must extend dose b/t time interval for patients with renal insufficiency
42
Q

What groups of antibiotics are cell wall inhibitors?

A

Penicillins, cephalosporins, carbapenems, monobactams

43
Q

What is the mechanism of action of cephalosporins?

A

Bactericidal
Break down Penicillin binding proteins in cell wall
- structurally & functionally similar to Penicillins
- affected by penicillinases & beta lactamases

44
Q

What drugs make up the first generation of cephalosporins?

A

PO: cephalexin (Keflex)
IV: cefazolin (ancef /kefzol )

45
Q

What drugs make up the second generation of cephalosporins?

A

Cefuroxime
-Cefuroxime axetil (Ceftin) IV/PO
Cefotetan IV
Cefoxitin IV

46
Q

What drugs make up the third generation of cephalosporins?

A 
IV:
Ceftriaxone (Rocephin)
Cefpodoxime proxetil (Vantin)
Cefotaxime (Claforan)
Ceftazidime (Fortaz)

PO:
Cefidinir (Omnicef)
Cefixime (suprax) PO

47
Q

What drug is a fourth generation of cephalosporin?

A

Cefepime (Maxipime) IV

48
Q

What drug is a fifth generation of cephalosporin?

A

Ceftaroline fosamil (Teflaro) IV

49
Q

What is the mechanism of action of all cephalosporins as a whole?

A

Bactericidal

Time dependent killing: duration of time above MEC is what matters

50
Q

What is the spectrum of activity of first generation cephalosporins? What type of infections are they commonly used for?

A

*Gram positive: Staphylococcus (most active)
Streptococcus sp.

Gram negative:
E. coli
Klebsiella sp.
Proteus sp.

  • good for skin infections
51
Q

What is the spectrum of activity of second generation cephalosporins on gram negative organisms? What type of infections are they commonly used for?

A

Gram negative

E. coli
Klebsiella sp.
Proteus sp.
H. influenza
Moraxella catarrhalis
  • good for respiratory pathogens
52
Q

What is the spectrum of activity of second generation cephalosporins on gram positive organisms and anaerobes?

A

Gram positive:
Staphylococcus (less active) & Streptococcus sp.

Anaerobes: Bacteroides

53
Q

What is the spectrum of activity of third generation cephalosporins on gram positive organisms?

A

Gram positive:

Staphylococcus (less active) & Streptococcus sp.

54
Q

What is the spectrum of activity of third generation cephalosporins on gram negative organisms?

A

Gram negative:
+ Pseudomonas
N. Gonorrhea

Covers same 1st & 2nd gen organisms:
E. coli
Klebsiella sp.
Proteus sp.
H. influenza
Moraxella catarrhalis
55
Q

How do 3rd generation cephalosporins differ from all others?

A

They are the only antibiotics that can cross the blood brain barrier
Good for meningitis: easier access in inflammation

56
Q

What is the spectrum of activity of 4th generation cephalosporins on gram negative organisms?

A

+ pseudomonas

57
Q

What is the spectrum of activity of 4th generation cephalosporins on gram positive organisms?

A

Streptococcus & Staphylococcus

58
Q

What is the spectrum of activity for 5th generation cephalosporins?

A

MRSA: 5th gen cephalosporins are the only generation that can cover MRSA
Streptococcus
Similar gram negative activity as ceftriaxone

Pharmacology (7 decks)

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