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Parker: Pulmonary pharmacology > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

What are the natural penicillins and what do they treat?

A 
PCN V (oral) and PCN G (parenteral). 
They treat SAC: Strep pneumoniae, Actinomyces, and Corynebacterium
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2
Q

What are the aminopenicillins and what do they treat?

A

Ampicillin (parenteral or oral) and Amoxicillin (oral)

They treat SHEL: Strep pneumo, H. flu, E. Coli, and Listeria

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3
Q

Combo of ampicillin/sulbactam is called? What does it treat?

A

Unasyn: treats community acquired pneumo, H. flu, and Moraxella

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4
Q

What is the only PCN you can take with meals?

A

Amoxicillin

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5
Q

Does PCN get into the meninges?

A

Only if the meninges are inflammed

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6
Q

In what organ(s) are the PCNs metabolized?

A

Liver & Kidney (must adjust for renal failure)

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7
Q

What two drugs does PCN compete with for renal excretion?

A

Aspirin, probeniced. If one of these drugs is in your body along with PCN, one of the drugs will “outcompete” the other for renal excretion.

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8
Q

What are the adverse reactions with PCN?

A
  1. Nausea/vomiting
  2. Hypersensitivity reactions (can be anaphylactic). Mediated via IgE and histamine release
  3. Pen G in high doses can be toxic to kidneys
  4. Diarrhea after oral dose
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9
Q

What is the mech of action of all the beta lactams (such as PCN, cephalosporins, and carbapenems)?

A

Inhibit formation of peptidoglycan cross-links in bacterial cell walls. A bacterial enzyme called beta lactamase can destroy the beta lactams and thus the bacteria can become resistant

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10
Q

What is the only cephalosporin on the condensed drug list?

A

Ceftriaxone

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11
Q

What are the 3 characteristics that make cephalosporins (Ceftriaxone) better than PCN?

A
  1. Broader
  2. Less hypersensitivity
  3. Less problems with bugs becoming resistant
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12
Q

What might you combine Ceftriaxone with to treat a nursing home patient with pneumonia?

A

Combine Ceftriaxone with an AMG (amikacin, gentamicin). You are treating P. aeruginosa (the most common nosocomial cause of pneumonia)

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13
Q

Can you take Ceftriaxone as a prophylactic?

A

Hell no! It is too powerful for that shit!

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14
Q

Ceftriaxone can also treat bacterial infection of what other “organ”? …think a red liquid..

A

Bacteremias! Bacterial infections in blood

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15
Q

Ceftriaxone is a champion at treating bacterial meningitis, why?

A

It crosses the BBB easily and gets into the CSF

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16
Q

How is Ceftriaxone excreted?

A

Kidneys (dose must be adjusted for renal failure)

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17
Q

What are 3 adverse reactions with Ceftriaxone?

A
  1. Nephrotoxic at high doses
  2. Severe pain with IM injections
  3. Hypersensitivity (but not as bad as PCN and rarely anaphylactic)
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18
Q

What beta lactam group has the highest of resistance to bacterial resistance?

A

The carbapenems

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19
Q

This carbapenem is commonly combined with cilastatin, a dehydropeptidase inhibitor

A

Imipenem

20
Q

What is a major ADE of Imipenem?

A

Seizures

21
Q

How is Meropenem different that Imipenem? (3 ways)

A
  1. You dont have to combine it with cilastatin
  2. Less seizures
  3. Less activity against Gram + cocci (S. aureus)
22
Q

What is the MOA of the macrolides? Also, list the macrolides that are on the consolidated drug list

A

Erythromycin and Clarithromycin. MOA: bind to 50S ribosomal subunit

23
Q

Are the macrolides bacteriostatic or bactericidal?

A

Erythromycin is bacteriostatic ONLY! Clarithromycin can be bacteriocidal at high doses

24
Q

How do drugs generate resistance to Erythromycin?

A

The Erm gene methylates the 50S subunit thereby altering the drug’s target. This is the MLSB phenotype

25
Q

What 3 places (organs or cells) does Erythromycin concentrate?

A
  1. Prostatic fluid
  2. Liver (check LFT’s)
  3. Macrophages
26
Q

How are the macrolides excreted?

A

Bile/feces

27
Q

Possible ADE’s of macrolides?

A

It is a CYP3A inhibitor. Can lead to heart problems like torsades de pointes, arrhythmias, prolonged QT interval (along with FQ’s and first generation anti-histamines), and sudden death

28
Q

What is the main reason you would use a macrolide?

A

If your patient has a PCN allergy

29
Q

Does charithromycin absorption decrease or increase with food?

A

Increases

30
Q

Clarithromycin is eliminated by what organs?

A

Liver, kidneys (must adjust dose for renal failure)

31
Q

Are the potentially severe heart problem side effects of clarithromycin as bad as erythromycin?

A

No, they’re not as bad.

32
Q

List the fluoroquinolones (FQ’s) and their mech of action

A

Levofloxacin, Moxifloxacin. MOA: inhibits bacterial DNA gyrase –> bacteriocidal

33
Q

How does a bacteria go about generating resistance against FQ’s?

A

A bacterial mutation of its DNA gyrase, specifically at the QRDR moiety.

34
Q

You can combine a carbapenem and an AMG (amikacin) to treat what highly resistant bacteria?

A

Acinetobacter

35
Q

What might inhibit the absorption of the FQ’s?

A

Antacids like Al, Mg, Fe, and Zn

36
Q

Do the FQ’s get in the CSF?

A

No

37
Q

Where are the FQ’s excreted?

A

Via bile and kidneys (must adjust for renal failure)

38
Q

What 2 bugs are the FQ’s particularly good at treating?

A

Strep pneumo and S. aureus

39
Q

What are the ADE’s of the FQs?

A
  1. QT
  2. NSAID seizures
  3. Photosensitivity
40
Q

What drug can you combine with FQ to treat highly resistant Gram - organisms?

A

Beta lactam. In fact, the FQ’s are referred to as “AMG-lite” cuz you can combine them with a beta lactam and the side effects arent as bad as if you used an AMG (amikacin, gentamycin)

41
Q

What is the only tetracycline on the abbreviated drug list? What is its MOA?

A

Doxycycline. Binds 30S ribosomal subunit of bacteria. Bacteriostatic

42
Q

What may inhibit the absorption of doxy?

A

Milk and antacids

43
Q

Where does doxy like to distribute?

A

Bones & teeth (be careful giving this drug to kids!!)

44
Q

Metabolism of doxy?

A

Enterohepatic cycling

45
Q

Excretion of doxy?

A

Bile only, you dont have to worry about renal function!!

46
Q

What would a patient have if you were to treat them with doxy?

A

Atypical pneumonia

47
Q

ADE of doxy?

A
  1. Photosensitivity

2. Alters gut normal flora –> Candidiasis of GI tract

Parker: Pulmonary pharmacology (7 decks)

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