Antibiotics Flashcards
1
Q
bacterial organism classification
A
aerobic vs. anaerobic
gram-positive vs. gram-negative
atypicals (spirocytes, mycoplasma, chlamydia)
morphology (cocci, bacilli)
2
Q
empiric treatment
A
starting and agent prior to knowing the identification or susceptibilities of the organism
3
Q
selection of antibiotics
A
identification of infecting organism(s)
antimicrobial susceptibility
site of infection
patient factors
4
Q
antimicrobial susceptibility
A
tells which antibiotics will work at certain concentrations-susceptible, intermediate, resistant
5
Q
site of infection
A
can have a significant impact-blood brain barrier, joint infections, blood stream infections
6
Q
patient factors
A
allergies, kidney/liver function, ADRs
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
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
9
Q
bactericidal
A
eradicate the organism-‘killing’
10
Q
bacteriostatic
A
arrest growth and replication until the host immune system can eliminate the organism-“inhibits”
11
Q
antibiotic classifications
A
broad spectrum vs narrow spectrum
MOA classifications
12
Q
broad spectrum
A
active against a wide variety of microorganisms- gram positive, gram negative, anaerobe
13
Q
narrow spectrum
A
active against only a few species of microorganisms
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
15
Q
common antibiotic ADRs
A
antibiotic associated diarrhea
C. difficile diarrhea
allergic reactions/anaphylaxis
fungal superinfections
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
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
18
Q
drugs that weaken cell walls
A
penicillins
19
Q
structures include a beta-lactam ring
A
penicillins
20
Q
beta-lactam family includes
A
penicillins
cephalosporins
monobactam
carbapenems
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
22
Q
narrow spectrum penicilins: penicillinase sensitive
A
Penicillin G
Penicillin V
23
Q
narrow-spectrum penicillins: penicillinase resistant
A
nafcillin
oxacillin
diclocacillin
24
Q
broad spectrum penicillins
A
Ampicillin
Amoxicillin
25
extended-spectrum penicillin
pipercaillin
26
penicillin
narrow-spectrum penicillinase-sensitive penicillins
27
antistaphylococcal penicillins
narrow-spectrum penicillinase-resistant penicillins
28
aminopenicillins
broad spectrum penicillins
29
streptococcus species, Neisseria species, many anaerobes, spirocytes, others
narrow-spectrum penicillins-penicillinase sensitive
30
staphylococcus aureus
narrow-spectrum penicillins-penicillinase resistant
31
haemophilus influenzae, e. coli, proteus mirabilis, enterococci, neisseria gonorrhoeae
broad-spectrum penicillins
32
haemophilus influenzae, e. coli, proteus mirabilis, enterococci, neisseria gonorrhoeae, pseudomonas aeruginosa, enterobacter species, proteus (indole positive), bacteroides fragilis, many klebsiella
extended-spectrum penicillin
33
Unasyn
ampicillin/sulbactam
34
augmentin
amoxicillin/clavulanic acid
35
Zosyn
piperacillin/tazobactam
36
penicillin uses
group A strep pharyngitis
group B strep prophylaxis in OB
syphilis
other susceptible infections
37
penicillin US boxed warnings
appropriate administration of IM only products-IV administration inappropriately has led to cardiorespiratory arrest and death
38
penicillin ADRs
allergic reactions-most common of all drug allergies
| pain at IV and IM injection sites
39
What are the antistaphylococcal penicillins?
Nafcillin
Oxacillin
Dicloxacillin
40
antistaphylococcal penicillins uses
MSSA infections (bacteremia, joint infections, endocarditis)
41
active against penicillinase-producing strains of staphylococcus (MSSA, S. epidermis)
antistaphylococcal penicillins
42
NO activity against methicillin-resistant Staphylococcus aureus (MRSA)
antistaphylococcal penicillins
43
antistaphylococcal penicillins ADRs
allergic reactions-most common of all drug allergies
44
antistaphylococcal penicillins metabolism/excretion
no renal or hepatic adjustments needed
45
aminopenicillins uses
group A strep pharyngitis
group B strep prophylaxis in OB
syphilis
increased activity against gram negative bacteria including: Haemophilus influenzae, E. coli, Salmonella, Shigella
46
widely inactivated by beta-lactamases-but still widely used and effective--> watch for lack of clinical response
aminopenicillins
47
excellent for cellulitis with anaerobe involvement and aspiration pneumonia
IV Unasyn
48
aminopenicillins ADRs
allergic reactions-most common of all drug allergies
49
aminopenicillins metabolism/excretion
renal adjustments needed but no hepatic adjustments needed
50
Beta-lactamase inhibitors
clavulanic acid (clavulanate)
tazobactam
sulbactam
avibactam
51
extend microbial spectrum of activity when combined with beta-lactam
ampicillin/sulbactam--> Unasyn
amoxicillin/clavulanic acid--> Augmentin
piperacillin/tazobactam-->Zosyn
52
give activity back to the penicillinase- or cephalosporinase-sensitive bacteria
beta-lactamase inhibitors
53
Zosyn uses
broad-spectrum antibiotic in a variety of infections-pneumonia, complicated cellulitis, osteomyelitis, sepsis of unknown origin, catheter related infections
54
covers MSSA (usually), pseudomonas, and anaerobes and everything in between
Zosyn
55
lacks: MRSA, atypical bacteria, vancomycin resistant enterococcus (VRE)
Zosyn
56
primarily used when pseudomonas or other resistant gram negative bacteria is suspected or confirmed
Zosyn
57
Zosyn ADRs
acute kidney injury-particularly in combination with other nephrotoxic drugs
58
Zosyn metabolism/excretion
renal adjustments needed but no hepatic adjustments needed
59
drugs that weaken bacterial cell walls
```
monobactam
carbapenems
cephalosporins
glycopeptides
fosfomycin
```
60
monobactam-aztreonam
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
61
monobactam-aztreonam ADRs
neutropenia-particularly in children
| increased AST, ALTs
62
monobactam-aztreonam metabolism/excretion
renal adjustments needed but no hepatic adjustment needed
63
carbapenems
extremely broad-spectrum antibiotics-restricted at most institutions (reserved for infectious disease consult or positive cultures/susceptibilities)
64
carbapenems drugs
Doripenem
Imipenem
Meropenem
Ertapenem
65
Doripenem, Imipenem, Meropenem
cover MSSA to pseudomonas
| dosed 2-3 times daily
66
Ertapenem
no pseudomonas coverage
dosed once daily
great outpatient infusion drug for MDR gram negatives
67
Doripenem, Imipenem, Meropenem, Ertapenem
all have coverage of anaerobes
68
most resistant bacteria out there
Carbapenem Resistant Enterobacteriaceae (CRE)
69
carbapenems have little to no cross-reactivity with
penicillins or cephalosporins (get a decent amount of use because of drug allergies)
70
carbapenems metabolism/excretion
renal adjustments needed but no hepatic adjustment needed
71
cephalosporins are the
most widely used group of antibiotics
72
cephalosporins
beta-lactam antibiotics
| structure similar to penicillin
73
cephalosporin MOA
binds to PDPs, disrupts cell wall synthesis, causing cell lysis
74
cross-reactivity of cephalosporins to penicillins
1-4%--> more likely that they are allergic to two different antibiotic classes that are truly cross reactive
75
cephalosporins are comprised of
5 generations with each generation having a slightly unique spectrum of activity
76
cephalosporin 1st generation uses
surgery prophylaxis, skin-soft tissue infections (Ancef-MSSA), UTIs (Keflex)
77
cephalosporin 1st generation drugs
cephalexin
| cefazolin
78
Cephalexin
Keflex
79
Cafazolin
Ancef
80
3rd generation cephalosporins
Ceftriaxone (Rocephin)
Ceftazidime
Cefdinir
81
Ceftriaxone
Rocephin
82
Rocephin uses
```
*very commonly prescribed in the hospital
community acquired pneumonia
UTI
gram negative bacteria
meningitis
```
83
Ceftazidime uses
pseudomonas coverage
| used in neonates and in peritoneal dialysis for peritonitis
84
Cefdinir uses
oral agent used in a lot of respiratory bacterial infections
85
2nd generation cephalosporins
cefuroxime
86
cefuroxime
oral agent used in many types of infections- a lot of respiratory bacterial infections when cultures never resulted
87
4th generation cephalosporins
Cefepime
88
Cefepime
pseudomonal coverage
similar uses to Zosyn except no anaerobic coverage
does not have same risk of nephrotoxicity
89
5th generation cephalosporins
Ceftaroline
90
Ceftaroline
rarely used
| has MRSA coverage
91
only cephalosporin that covers MRSA
Ceftaroline
92
glycopeptides
group of antibiotics with gram positive activity used primarily in MRSA, patient with penicillin allergies, and C. difficile infections- no gram-negative coverage
93
Glycopeptides MOA
inhibit cell wall synthesis and thus promote bacterial lysis and death
94
The primary Glycopeptide antibiotic is ____
Vancomycin
95
vancomycin for C. diff treatment
site of action is topically int he GI tract, so the lack of oral absorption is capitalized on
96
vancomycin
Vanco
97
Vanco uses
used frequently in cellulitis cases as it covers staph and strep until cultures/sensitives are resulted and gram-positive bacteria
98
Vanco ADRs
nephrotoxic-renal failure
red man syndrome
thrombocytopenia
99
vanco nephrotoxic ADR
dose related and more common with additive nephrotoxic drugs, blood level monitoring and adjustments, monitor serum creatin values
100
vanco red man syndrome
rapid infusion can cause histamine release- flushing, rash, pruritis, tachycardia, hypotension
101
Vanomycin (vanco) routes of administration
IV for all indications except C. difficile which is oral
102
Fosfomycin indications
uncomplicated UTI: covers pseudomonas, GNRs, enterococcus (even VRE); only effective in the bladder
103
Fosfomycin MOA
inhibits bacterial cell wall synthesis
104
Fosfomycin ADRs
well tolerates- no ADRs >10%
105
Fosfomycin metabolism/excretion
no renal or hepatic adjustments but elimination is significantly prolonged in renal impaired patients
106
tetracyclines
Tetracycline
Demeclocycline (not used as an antibiotic)
Doxycycline
Minocycline
107
doxycycline common uses
pneumonia
cellulitis
covers MRSA
108
tetracycline common use
acne
109
minocycline common use
acne
110
all tetracyclines common uses
atypical bacteria infections (anthrax, malaria, syphilis, cholera, lyme disease)
gram positive bacteria
gram negative bacteria
atypical bacteria
111
Tetracyclines MOA
inhibits bacterial protein synthesis
112
Tetracyclines ADRs
```
tooth mottling (discolors yellow or brown)-irreversible
GI irritation (NVD, epigastric burning)
photosensitivity (increased risk of sunburn)
```
113
significant absorption chelation can occur and prevents absorption-Ca, Mg, Iron (positive cations) with
tetracyclines
114
Macrolides
Azithromycin
Erythromycin
Clarithromycin
115
Macrolides cover
gram positive bacteria
gram negative bacteria
atypical bacteria
no MRSA or pseudomonas
116
Azithromycin common uses
upper respiratory infections
pneumonia
COPD exacerbations
sinus infections
117
Erythromycin common uses
acne (topical products)
| GI motility in gastroparesis
118
Clarithromycin common uses
not used often
119
Macrolides MOA
inhibit bacterial protein synthesis
120
Azithromycin ADRs
QT prolongation-increased risk of fatal heart rhythms
121
Macrolides metabolism/excretion
no renal or hepatic adjustments needed
122
Macrolides significant drug interactions
Clarithromycin is a strong CYP 3A4 inhibitor
123
clindamycin uses
gram positive bacteria and anaerobic infections
does not cover gram negative bacteria
typically covers MRSA
124
clindamycin US boxed warnings
C. diff colitis-potentially severe and life-threatening
125
clindamycin MOA
inhibits bacterial protein synthesis
126
clindamycin ADRs
antibiotic associated diarrhea and c. diff diarrhea
127
clindamycin matabolism/excretion
no renal or hepatic adjustments needed
128
linezolid uses
covers gram positive bacteria only
no gram negative or anaerobes
covers MRSA, VRE
129
linezolid contraindications
concurrent use or within 2 weeks of monoamine oxidase inhibitors (MAOIs)
130
linezolid ADRs
diaarhea
131
linezolid metabolism/excretion
increased risk of serotonin syndrome in combination with SSRIs and SNRIs
132
aminoglycosides
bactericidal-concentration dependent agents
gentamicin, tobramycin, amikacin, neomycin
133
aminoglycosides uses
cover gram negatives (including CRE)
severe gram-negative infections
multi-drug resistant organisms
pre-operative antibiotics
134
aminoglycosides US boxed warnings
nephrotoxicity: typically, irreversible-proper monitoring
ototoxicity: typically, irreversible-individuals with renal dysfunction are more susceptible
pregnancy: can cause fetal harm
135
aminoglycosides MOA
inhibits bacterial protein synthesis
136
aminoglycosides metabolism/excretion
pharmacy to dose
peaks for concentration dependent killing, troughs to minimize toxicity
137
aminoglycoside pharmacokinetics
post-antibiotic effect (PAR): continues killing even after concentration is below MIC
extends interval dosing versus traditional dosing
138
sulfonamides-sulfamethoxazole/trimethoprim uses
cellulitis, UTI, gram positive infections, MRSA coverage
139
sulfonamides-sulfamethoxazole/trimethoprim contraindications
history of drug induced-immune thrombocytopenia
140
sulfonamides-sulfamethoxazole/trimethoprim ADRs
hyperkalemia
hypersensitivity reactions
141
sulfonamides-sulfamethoxazole/trimethoprim hyperkalemia
blocks sodium channels in the distal nephron-inhibits potassium secretion-potenially fatal
142
sulfonamides-sulfamethoxazole/trimethoprim hypersensitivity reactions-delayed and immediate
immediate: typical rash, angioedema, anaphylaxis
delayed: severe forms of rashes- Stevens- Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN)
143
sulfonamides-sulfamethoxazole/trimethoprim metabolism/excretion
renal adjustment needed, no hepatic adjustment needed
144
other sulfonamide derivative antibiotics
sulfacetamide
silvadene
sulfadiazine
145
sulfacetamide
topical for acne, bacterial infections, scaling dermatoses, ophthalmic infections
146
silvadene
silver sulfadiazine
topical for burn treatment
prevention and treatment of wound sepsis
147
sulfadiazine
toxoplasmosis treatment-not first line
148
fluoroquinolones indications
cover gram positive bacteria (poorly staphylococcal and no MRSA)
gram negative bacteria (including pseudomonas)
atypical organisms
149
fluoroquinolones
moxifloxacin
levaquin (levofloxacin)
cipro (ciprofloxacin)
150
moxifloxacin targets
anaerobes
151
respiratory fluoroquinolones
Levaquin
Moxifloxacin
152
non-respiratory fluoroquinolones
Cipro
153
fluoroquinolones US boxed warnings
serious adverse reactions-tendinitis and tendon rupture, peripheral neuropathy, CNS effects
exacerbation of myasthenia gravis
154
fluoroquinolones metabolism/excretion
require renal adjustment, no hepatic adjustment
absorption is decreased by cations (Ca, Zn, Al, Mg, Fe, etc.)-give 2hrs before or 6hrs after
155
fluoroquinolones ADRs
CNS effects/neuroexcitation
QT interval prolongation
tendon rupture/tendinopathy
phototoxicity
156
fluoroquinolones CNS effects/neuroexcitation
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
fluoroquinolones QT interval prolongation
torsades de pointes-higher occurrence in combination with other QT prolonging drugs
158
fluoroquinolones tendon rupture/tendinopathy
most often the achilles tendon-direct effect on chondrocytes and tenocytes responsible for collagen synthesis
159
fluoroquinolones phototoxicity
increased sensitivity to the sun
160
metronidazole
flagyl
161
flagyl indications
anaerobic bacterial infections, trichomoniasis, surgical prophylaxis, amebiasis
162
flagyl US boxed warnings
carcinogenic in mice and rats
163
flagyl contraindications
first trimester pregnancy, alcohol-disulfiram reaction
164
flagyl ADRs
nausea, headache
metallic taste
165
flagyl metabolism/excretion
reduce dose by 50% in severe liver impairment, no renal adjustments needed
166
rifampin indications
tuberculosis, meningococci, eliminations from nasopharynx, many off label uses
never to be used alone in bacterial treatment-resistant develops rapidly
167
rifampin contraindications
concurrent use of HIV and Hep C drugs
strong inducer of CYP 34A and other CYPs
168
rifampin ADRs
discolors body fluids-red/orange color
169
rifampin metabolism/excretion
no dosage adjustments in renal or hepatic dysfunction
170
nitrofurantoin
macrobid
171
macrobid indications
UTIs and prophylaxis for recurrent UTIs
172
macrobid contraindications
anuria, oliguria, or significant impairment of renal function, previous history of cholestatic jaundice or hepatic dysfunction with prior use
173
macrobid ADRs
well tolerated-none >10%
174
macrobid metabolism/excretion
avoid use in CrCl <30 mL/min, caution in 30-60 CrCl, no hepatic adjustment
