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PAS 532 Practical Therapeutics 1 > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

bacterial organism classification

A

aerobic vs. anaerobic
gram-positive vs. gram-negative
atypicals (spirocytes, mycoplasma, chlamydia)
morphology (cocci, bacilli)

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2
Q

empiric treatment

A

starting and agent prior to knowing the identification or susceptibilities of the organism

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3
Q

selection of antibiotics

A

identification of infecting organism(s)
antimicrobial susceptibility
site of infection
patient factors

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4
Q

antimicrobial susceptibility

A

tells which antibiotics will work at certain concentrations-susceptible, intermediate, resistant

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5
Q

site of infection

A

can have a significant impact-blood brain barrier, joint infections, blood stream infections

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6
Q

patient factors

A

allergies, kidney/liver function, ADRs

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7
Q

selecting empiric therapy

A

influenced by site of infection

influenced by host factors-prior infections, social habits, travel history, immune system status, healthcare associated

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8
Q

initial therapy is typically broad-spectrum

A

unknown what organisms or if there are multiple–> guided by typical and suspected organisms

narrowed upon clinical improvement and culture/sensitivity data

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9
Q

bactericidal

A

eradicate the organism-‘killing’

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10
Q

bacteriostatic

A

arrest growth and replication until the host immune system can eliminate the organism-“inhibits”

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11
Q

antibiotic classifications

A

broad spectrum vs narrow spectrum

MOA classifications

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12
Q

broad spectrum

A

active against a wide variety of microorganisms- gram positive, gram negative, anaerobe

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13
Q

narrow spectrum

A

active against only a few species of microorganisms

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14
Q

MOA classifications

A

cell wall synthesis inhibitors
cell membrane disruption
bactericidal protein synthesis inhibitors
bacteriostatic protein synthesis inhibitors
antimetabolites
bacterial DNA/RNA synthesis or integrity inhibitors

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15
Q

common antibiotic ADRs

A

antibiotic associated diarrhea
C. difficile diarrhea
allergic reactions/anaphylaxis
fungal superinfections

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16
Q

antibiotic associated diarrhea

A

GI effects-NVD-typically mild and self-limiting
most antibiotics have at least some degree of causing
disrupts normal gut flora
potentially preventable with probiotics

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17
Q

C. difficile diarrhea

A

more severe and potentially life-threatening diarrhea caused by C. diff bacteria

overgrowth of a particular harmful bacteria

typically seen with more broad-spectrum antibiotics

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18
Q

drugs that weaken cell walls

A

penicillins

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19
Q

structures include a beta-lactam ring

A

penicillins

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20
Q

beta-lactam family includes

A

penicillins
cephalosporins
monobactam
carbapenems

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21
Q

penicillin’s MOA

A

disrupts cell wall by binding to penicillin-binding proteins (PBPs) to weaken it and allow bacteria to take up excess water and rupture–>bactericidal

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22
Q

narrow spectrum penicilins: penicillinase sensitive

A

Penicillin G

Penicillin V

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23
Q

narrow-spectrum penicillins: penicillinase resistant

A

nafcillin
oxacillin
diclocacillin

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24
Q

broad spectrum penicillins

A

Ampicillin

Amoxicillin

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25
Q

extended-spectrum penicillin

A

pipercaillin

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26
Q

penicillin

A

narrow-spectrum penicillinase-sensitive penicillins

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27
Q

antistaphylococcal penicillins

A

narrow-spectrum penicillinase-resistant penicillins

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28
Q

aminopenicillins

A

broad spectrum penicillins

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29
Q

streptococcus species, Neisseria species, many anaerobes, spirocytes, others

A

narrow-spectrum penicillins-penicillinase sensitive

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30
Q

staphylococcus aureus

A

narrow-spectrum penicillins-penicillinase resistant

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31
Q

haemophilus influenzae, e. coli, proteus mirabilis, enterococci, neisseria gonorrhoeae

A

broad-spectrum penicillins

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32
Q

haemophilus influenzae, e. coli, proteus mirabilis, enterococci, neisseria gonorrhoeae, pseudomonas aeruginosa, enterobacter species, proteus (indole positive), bacteroides fragilis, many klebsiella

A

extended-spectrum penicillin

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33
Q

Unasyn

A

ampicillin/sulbactam

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34
Q

augmentin

A

amoxicillin/clavulanic acid

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35
Q

Zosyn

A

piperacillin/tazobactam

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36
Q

penicillin uses

A

group A strep pharyngitis
group B strep prophylaxis in OB
syphilis
other susceptible infections

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37
Q

penicillin US boxed warnings

A

appropriate administration of IM only products-IV administration inappropriately has led to cardiorespiratory arrest and death

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38
Q

penicillin ADRs

A

allergic reactions-most common of all drug allergies

pain at IV and IM injection sites

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39
Q

What are the antistaphylococcal penicillins?

A

Nafcillin
Oxacillin
Dicloxacillin

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40
Q

antistaphylococcal penicillins uses

A

MSSA infections (bacteremia, joint infections, endocarditis)

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41
Q

active against penicillinase-producing strains of staphylococcus (MSSA, S. epidermis)

A

antistaphylococcal penicillins

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42
Q

NO activity against methicillin-resistant Staphylococcus aureus (MRSA)

A

antistaphylococcal penicillins

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43
Q

antistaphylococcal penicillins ADRs

A

allergic reactions-most common of all drug allergies

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44
Q

antistaphylococcal penicillins metabolism/excretion

A

no renal or hepatic adjustments needed

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45
Q

aminopenicillins uses

A

group A strep pharyngitis
group B strep prophylaxis in OB
syphilis
increased activity against gram negative bacteria including: Haemophilus influenzae, E. coli, Salmonella, Shigella

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46
Q

widely inactivated by beta-lactamases-but still widely used and effective–> watch for lack of clinical response

A

aminopenicillins

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47
Q

excellent for cellulitis with anaerobe involvement and aspiration pneumonia

A

IV Unasyn

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48
Q

aminopenicillins ADRs

A

allergic reactions-most common of all drug allergies

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49
Q

aminopenicillins metabolism/excretion

A

renal adjustments needed but no hepatic adjustments needed

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50
Q

Beta-lactamase inhibitors

A

clavulanic acid (clavulanate)
tazobactam
sulbactam
avibactam

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51
Q

extend microbial spectrum of activity when combined with beta-lactam

A

ampicillin/sulbactam–> Unasyn
amoxicillin/clavulanic acid–> Augmentin
piperacillin/tazobactam–>Zosyn

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52
Q

give activity back to the penicillinase- or cephalosporinase-sensitive bacteria

A

beta-lactamase inhibitors

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53
Q

Zosyn uses

A

broad-spectrum antibiotic in a variety of infections-pneumonia, complicated cellulitis, osteomyelitis, sepsis of unknown origin, catheter related infections

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54
Q

covers MSSA (usually), pseudomonas, and anaerobes and everything in between

A

Zosyn

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55
Q

lacks: MRSA, atypical bacteria, vancomycin resistant enterococcus (VRE)

A

Zosyn

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56
Q

primarily used when pseudomonas or other resistant gram negative bacteria is suspected or confirmed

A

Zosyn

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57
Q

Zosyn ADRs

A

acute kidney injury-particularly in combination with other nephrotoxic drugs

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58
Q

Zosyn metabolism/excretion

A

renal adjustments needed but no hepatic adjustments needed

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59
Q

drugs that weaken bacterial cell walls

A 
monobactam
carbapenems
cephalosporins
glycopeptides
fosfomycin
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60
Q

monobactam-aztreonam

A

active against only gram-negative organisms-covers pseudomonas

used in infections with multiple-drug resistance-reserved agent

little to no allergy cross reactivity with penicillins or cephalosporins

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61
Q

monobactam-aztreonam ADRs

A

neutropenia-particularly in children

increased AST, ALTs

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62
Q

monobactam-aztreonam metabolism/excretion

A

renal adjustments needed but no hepatic adjustment needed

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63
Q

carbapenems

A

extremely broad-spectrum antibiotics-restricted at most institutions (reserved for infectious disease consult or positive cultures/susceptibilities)

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64
Q

carbapenems drugs

A

Doripenem
Imipenem
Meropenem
Ertapenem

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65
Q

Doripenem, Imipenem, Meropenem

A

cover MSSA to pseudomonas

dosed 2-3 times daily

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66
Q

Ertapenem

A

no pseudomonas coverage
dosed once daily
great outpatient infusion drug for MDR gram negatives

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67
Q

Doripenem, Imipenem, Meropenem, Ertapenem

A

all have coverage of anaerobes

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68
Q

most resistant bacteria out there

A

Carbapenem Resistant Enterobacteriaceae (CRE)

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69
Q

carbapenems have little to no cross-reactivity with

A

penicillins or cephalosporins (get a decent amount of use because of drug allergies)

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70
Q

carbapenems metabolism/excretion

A

renal adjustments needed but no hepatic adjustment needed

71
Q

cephalosporins are the

A

most widely used group of antibiotics

72
Q

cephalosporins

A

beta-lactam antibiotics

structure similar to penicillin

73
Q

cephalosporin MOA

A

binds to PDPs, disrupts cell wall synthesis, causing cell lysis

74
Q

cross-reactivity of cephalosporins to penicillins

A

1-4%–> more likely that they are allergic to two different antibiotic classes that are truly cross reactive

75
Q

cephalosporins are comprised of

A

5 generations with each generation having a slightly unique spectrum of activity

76
Q

cephalosporin 1st generation uses

A

surgery prophylaxis, skin-soft tissue infections (Ancef-MSSA), UTIs (Keflex)

77
Q

cephalosporin 1st generation drugs

A

cephalexin

cefazolin

78
Q

Cephalexin

A

Keflex

79
Q

Cafazolin

A

Ancef

80
Q

3rd generation cephalosporins

A

Ceftriaxone (Rocephin)
Ceftazidime
Cefdinir

81
Q

Ceftriaxone

A

Rocephin

82
Q

Rocephin uses

A 
*very commonly prescribed in the hospital
community acquired pneumonia
UTI
gram negative bacteria
meningitis
83
Q

Ceftazidime uses

A

pseudomonas coverage

used in neonates and in peritoneal dialysis for peritonitis

84
Q

Cefdinir uses

A

oral agent used in a lot of respiratory bacterial infections

85
Q

2nd generation cephalosporins

A

cefuroxime

86
Q

cefuroxime

A

oral agent used in many types of infections- a lot of respiratory bacterial infections when cultures never resulted

87
Q

4th generation cephalosporins

A

Cefepime

88
Q

Cefepime

A

pseudomonal coverage
similar uses to Zosyn except no anaerobic coverage
does not have same risk of nephrotoxicity

89
Q

5th generation cephalosporins

A

Ceftaroline

90
Q

Ceftaroline

A

rarely used

has MRSA coverage

91
Q

only cephalosporin that covers MRSA

A

Ceftaroline

92
Q

glycopeptides

A

group of antibiotics with gram positive activity used primarily in MRSA, patient with penicillin allergies, and C. difficile infections- no gram-negative coverage

93
Q

Glycopeptides MOA

A

inhibit cell wall synthesis and thus promote bacterial lysis and death

94
Q

The primary Glycopeptide antibiotic is ____

A

Vancomycin

95
Q

vancomycin for C. diff treatment

A

site of action is topically int he GI tract, so the lack of oral absorption is capitalized on

96
Q

vancomycin

A

Vanco

97
Q

Vanco uses

A

used frequently in cellulitis cases as it covers staph and strep until cultures/sensitives are resulted and gram-positive bacteria

98
Q

Vanco ADRs

A

nephrotoxic-renal failure
red man syndrome
thrombocytopenia

99
Q

vanco nephrotoxic ADR

A

dose related and more common with additive nephrotoxic drugs, blood level monitoring and adjustments, monitor serum creatin values

100
Q

vanco red man syndrome

A

rapid infusion can cause histamine release- flushing, rash, pruritis, tachycardia, hypotension

101
Q

Vanomycin (vanco) routes of administration

A

IV for all indications except C. difficile which is oral

102
Q

Fosfomycin indications

A

uncomplicated UTI: covers pseudomonas, GNRs, enterococcus (even VRE); only effective in the bladder

103
Q

Fosfomycin MOA

A

inhibits bacterial cell wall synthesis

104
Q

Fosfomycin ADRs

A

well tolerates- no ADRs >10%

105
Q

Fosfomycin metabolism/excretion

A

no renal or hepatic adjustments but elimination is significantly prolonged in renal impaired patients

106
Q

tetracyclines

A

Tetracycline
Demeclocycline (not used as an antibiotic)
Doxycycline
Minocycline

107
Q

doxycycline common uses

A

pneumonia
cellulitis
covers MRSA

108
Q

tetracycline common use

A

acne

109
Q

minocycline common use

A

acne

110
Q

all tetracyclines common uses

A

atypical bacteria infections (anthrax, malaria, syphilis, cholera, lyme disease)
gram positive bacteria
gram negative bacteria
atypical bacteria

111
Q

Tetracyclines MOA

A

inhibits bacterial protein synthesis

112
Q

Tetracyclines ADRs

A 
tooth mottling (discolors yellow or brown)-irreversible
GI irritation (NVD, epigastric burning)
photosensitivity (increased risk of sunburn)
113
Q

significant absorption chelation can occur and prevents absorption-Ca, Mg, Iron (positive cations) with

A

tetracyclines

114
Q

Macrolides

A

Azithromycin
Erythromycin
Clarithromycin

115
Q

Macrolides cover

A

gram positive bacteria
gram negative bacteria
atypical bacteria
no MRSA or pseudomonas

116
Q

Azithromycin common uses

A

upper respiratory infections
pneumonia
COPD exacerbations
sinus infections

117
Q

Erythromycin common uses

A

acne (topical products)

GI motility in gastroparesis

118
Q

Clarithromycin common uses

A

not used often

119
Q

Macrolides MOA

A

inhibit bacterial protein synthesis

120
Q

Azithromycin ADRs

A

QT prolongation-increased risk of fatal heart rhythms

121
Q

Macrolides metabolism/excretion

A

no renal or hepatic adjustments needed

122
Q

Macrolides significant drug interactions

A

Clarithromycin is a strong CYP 3A4 inhibitor

123
Q

clindamycin uses

A

gram positive bacteria and anaerobic infections

does not cover gram negative bacteria

typically covers MRSA

124
Q

clindamycin US boxed warnings

A

C. diff colitis-potentially severe and life-threatening

125
Q

clindamycin MOA

A

inhibits bacterial protein synthesis

126
Q

clindamycin ADRs

A

antibiotic associated diarrhea and c. diff diarrhea

127
Q

clindamycin matabolism/excretion

A

no renal or hepatic adjustments needed

128
Q

linezolid uses

A

covers gram positive bacteria only

no gram negative or anaerobes

covers MRSA, VRE

129
Q

linezolid contraindications

A

concurrent use or within 2 weeks of monoamine oxidase inhibitors (MAOIs)

130
Q

linezolid ADRs

A

diaarhea

131
Q

linezolid metabolism/excretion

A

increased risk of serotonin syndrome in combination with SSRIs and SNRIs

132
Q

aminoglycosides

A

bactericidal-concentration dependent agents

gentamicin, tobramycin, amikacin, neomycin

133
Q

aminoglycosides uses

A

cover gram negatives (including CRE)

severe gram-negative infections

multi-drug resistant organisms

pre-operative antibiotics

134
Q

aminoglycosides US boxed warnings

A

nephrotoxicity: typically, irreversible-proper monitoring
ototoxicity: typically, irreversible-individuals with renal dysfunction are more susceptible
pregnancy: can cause fetal harm

135
Q

aminoglycosides MOA

A

inhibits bacterial protein synthesis

136
Q

aminoglycosides metabolism/excretion

A

pharmacy to dose

peaks for concentration dependent killing, troughs to minimize toxicity

137
Q

aminoglycoside pharmacokinetics

A

post-antibiotic effect (PAR): continues killing even after concentration is below MIC

extends interval dosing versus traditional dosing

138
Q

sulfonamides-sulfamethoxazole/trimethoprim uses

A

cellulitis, UTI, gram positive infections, MRSA coverage

139
Q

sulfonamides-sulfamethoxazole/trimethoprim contraindications

A

history of drug induced-immune thrombocytopenia

140
Q

sulfonamides-sulfamethoxazole/trimethoprim ADRs

A

hyperkalemia

hypersensitivity reactions

141
Q

sulfonamides-sulfamethoxazole/trimethoprim hyperkalemia

A

blocks sodium channels in the distal nephron-inhibits potassium secretion-potenially fatal

142
Q

sulfonamides-sulfamethoxazole/trimethoprim hypersensitivity reactions-delayed and immediate

A

immediate: typical rash, angioedema, anaphylaxis
delayed: severe forms of rashes- Stevens- Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN)

143
Q

sulfonamides-sulfamethoxazole/trimethoprim metabolism/excretion

A

renal adjustment needed, no hepatic adjustment needed

144
Q

other sulfonamide derivative antibiotics

A

sulfacetamide

silvadene

sulfadiazine

145
Q

sulfacetamide

A

topical for acne, bacterial infections, scaling dermatoses, ophthalmic infections

146
Q

silvadene

A

silver sulfadiazine

topical for burn treatment

prevention and treatment of wound sepsis

147
Q

sulfadiazine

A

toxoplasmosis treatment-not first line

148
Q

fluoroquinolones indications

A

cover gram positive bacteria (poorly staphylococcal and no MRSA)

gram negative bacteria (including pseudomonas)

atypical organisms

149
Q

fluoroquinolones

A

moxifloxacin

levaquin (levofloxacin)

cipro (ciprofloxacin)

150
Q

moxifloxacin targets

A

anaerobes

151
Q

respiratory fluoroquinolones

A

Levaquin

Moxifloxacin

152
Q

non-respiratory fluoroquinolones

A

Cipro

153
Q

fluoroquinolones US boxed warnings

A

serious adverse reactions-tendinitis and tendon rupture, peripheral neuropathy, CNS effects

exacerbation of myasthenia gravis

154
Q

fluoroquinolones metabolism/excretion

A

require renal adjustment, no hepatic adjustment

absorption is decreased by cations (Ca, Zn, Al, Mg, Fe, etc.)-give 2hrs before or 6hrs after

155
Q

fluoroquinolones ADRs

A

CNS effects/neuroexcitation

QT interval prolongation

tendon rupture/tendinopathy

phototoxicity

156
Q

fluoroquinolones CNS effects/neuroexcitation

A

wide range of effects-dizziness/restlessness to confusion, agitation, insomnia, psychosis, hallucinations, suicidal ideation and tendencies-higher possibility in elderly and poor renal function

157
Q

fluoroquinolones QT interval prolongation

A

torsades de pointes-higher occurrence in combination with other QT prolonging drugs

158
Q

fluoroquinolones tendon rupture/tendinopathy

A

most often the achilles tendon-direct effect on chondrocytes and tenocytes responsible for collagen synthesis

159
Q

fluoroquinolones phototoxicity

A

increased sensitivity to the sun

160
Q

metronidazole

A

flagyl

161
Q

flagyl indications

A

anaerobic bacterial infections, trichomoniasis, surgical prophylaxis, amebiasis

162
Q

flagyl US boxed warnings

A

carcinogenic in mice and rats

163
Q

flagyl contraindications

A

first trimester pregnancy, alcohol-disulfiram reaction

164
Q

flagyl ADRs

A

nausea, headache

metallic taste

165
Q

flagyl metabolism/excretion

A

reduce dose by 50% in severe liver impairment, no renal adjustments needed

166
Q

rifampin indications

A

tuberculosis, meningococci, eliminations from nasopharynx, many off label uses

never to be used alone in bacterial treatment-resistant develops rapidly

167
Q

rifampin contraindications

A

concurrent use of HIV and Hep C drugs

strong inducer of CYP 34A and other CYPs

168
Q

rifampin ADRs

A

discolors body fluids-red/orange color

169
Q

rifampin metabolism/excretion

A

no dosage adjustments in renal or hepatic dysfunction

170
Q

nitrofurantoin

A

macrobid

171
Q

macrobid indications

A

UTIs and prophylaxis for recurrent UTIs

172
Q

macrobid contraindications

A

anuria, oliguria, or significant impairment of renal function, previous history of cholestatic jaundice or hepatic dysfunction with prior use

173
Q

macrobid ADRs

A

well tolerated-none >10%

174
Q

macrobid metabolism/excretion

A

avoid use in CrCl <30 mL/min, caution in 30-60 CrCl, no hepatic adjustment

PAS 532 Practical Therapeutics 1 (4 decks)

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