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Pharmacy CPS Flashcards > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Which organism is always coagulase positive?

A

Staph aureus

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2
Q

Bacteriocidal vs Bacteriostatic

A

Cidal: kills bacteria
Static: stops the reproduction of the bacteria

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3
Q

Should you use bacteriocidal or static in immunocompromised patients?

A

CIDAL

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4
Q

Penicillins MOA

A

Bind to penicillin binding protein resulting in inhibition of peptidoglycan synthesis and activation of autolytic enzymes in cell wall
Bactericidal (kills)

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5
Q

Penicillins modes of resistance

A
  • Production of B lactamase enzymes
  • Lack of PBPs or altered PBPs
  • Efflux of drug out of cell
  • Failure to synthesize peptidoglycans such as mycoplasmas or metabolically inactive bacteria
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6
Q

Natural penicillin and coverage

A

Pen G
Acid labile: injection only
Treats gram positive infections like strepococci, pneumococci, meningcocci, spirochetes (syphillis), clostridia, enterococci, etc

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7
Q

Methicillin, cloxacillin

A

Isoxazolyl penicillins

Coverage: more designed for S. aureus. Less GP and no MRSA coverage

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8
Q

Aminopenicillins

A

Amoxicillin (PO), Ampicillin (IV) -> amp more acid labile than pen and poor F
Coverage: GP (strep, enterococci) and GN (neiserria, e coli, non beta lactamase h influenzae, P mirabilis, etc)
Not good for staph

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9
Q

Beta lactamase inhibitor

A

Clavulanic acid
Now good for staph
Beta-lactamases open the beta-lactam ring of penicillins and cephlaosporins; no longer active
ESBL (extended spectrum beta lactamases) found in E. Coli and Klebsiella pneumoniae
- beta lactamase inhibitors cannot stop ESBLs BTW!!!

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10
Q

Ureidopenicillins

A

Piperacillin
Coverage for Pseudomonas!!
Parenteral only because very acid labile
Available with tazobactam (B lactam inhibitor)

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11
Q

How are penicillins excreted?

A

By the kidney

  • Cloxacillin can be excreted by liver if kidneys arent great
  • Pen G will accumulate if kidneys suck

Penicillins are great at getting places like lungs, meningiitis, etc.`

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12
Q

Adverse effects of penicillins

A

N/V/D, skin rash, allergic reactions, fever/nephritis/esoinophilia as a triad, CNS symptoms

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13
Q

General penicillin facts

A

Concentration independent killing
All taken on empty stomach except for amoxi
Distributed in breastmilk but low risk and safe in pregnancy
Can use in immunocompromised

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14
Q

Cephalosporin MOA

A

Same as penicillins, PBP and peptidoglycan and cell wall n shit
Bacteriocidal

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15
Q

Cephalosporin resistance

A
  • Lack of or altered PBP
  • Beta lactamase production
  • Resistance to beta lactams
  • Efflux
  • Inability of drug to penetrate
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16
Q

First gen cephs and coverage

A

Cefazolin, cephalexin, cefadroxil
Gram positive, not enterococci or MRSA
Gram negative, PEK (Proteus, E coli, Klebsiella)

Does not cross the BBB btw

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17
Q

Second gen cephs and coverage

A

Cefuroxime (IV/IM/PO), cefprozil (PO)
Cefoxitin = cephamycin, good for diabetic foot infections (mixed infection of ana and aerobic)
Coverage: gram positive (same as first), gram negative H PEK (add h influenzae), moraxella

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18
Q

3rd gen cephs and coverage

A

Cefotaxime (kidney), ceftriaxone (liver)
Cefixime (oral) used for gonorrhea
Ceftazidime (reserve for Pseudomonas as only one that covers it)
Less gram positive coverage (except strep) and way more gram negative bacilli coverage
HEN PEKS
Ability to penetrate CNS for brain infections

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19
Q

4th gen cephs and coverage

A

Cefepime - enhanced activity against enterbacter and citrobacter, simliar gram positive coverage and better gram negative. Not good for MRSA though
Ceftaroline and Ceftobiprole have activity against MRSA, E facaelis, and pen resisitant strep pneumoniae

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20
Q

Adverse effects of cephalosporins in general

A

Diarrhea, hypersensitivity, skin rash, fever

Low risk of cross sensitivity

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21
Q

Carbapenems

A

Meropenem, ertapenem, imipenem-cilastin (prevents breakdown by renal peptidases)
Structurally similar to penicillins
Gram positive, gram negative coverage, anaerobes, very broad spectrum
Ertapenem does not have Pseudomonas coverage but the other two do, and less enterococci than the other two as well (but the enterococci coverage sucks for all of them really)
Seizure risk imipenem>meropenem
Similar a/e to cephs

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22
Q

Macrolides and MOA

A

Erythromycin, clarithromycin, azithromycin
Attach to the 23S rRNA on the 50S subunit of bacterial ribosome resulting in inhibition of protein synthesis
Human cells do not have the 50S subunit, so very specific
Bacteriostatic

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23
Q

Macrolide mode of resistance

A
  • Methylation of RNA receptor
  • Inactivating enzymes encoded by mef genes
  • Active efflux msr gene
24
Q

Macrolide coverage

A

Large
Gram positive - streptococci, pneumococci, corneybacteria
And M pneumoniae, Chlamydia trachomatis, L pneumophilia, campylobacter jejuni
Also covers those that lack a typical cell wall

25
Q

Why is erythromycin not used as IV?

A

Causes phlebitis

26
Q

Erythromycin A/E

A

GI, cholestatic hepatitis, QT prolongation

27
Q

Clarithromycin and azithromycin specifics

A

Same coverage as erythromycin (staph and strep) but enhanced activity against organisms such as L. Pneumophilia, Chlamydia trachomatis, Moraexlla catarrhalis, H. Influenzae (azithro), Mycobacterium avium complex and other mycobacteria
Useful for some MRSA
If resistant to erythromycin, then resistant to all
Lower rate of GI s/e but still main ones
Azithromycin has least amount of DI

28
Q

Clindamycin

A

MOA same as macrolides
Spectrum: anaerobes, Staph aureus, Strep, some MRSA
Used in those with pen allergies
High risk of C diff

29
Q

Tetracyclines and MOA

A

Tetracycline, minocycline, doxycycline
Inhibit binding of aminoacyl-tRNA to the 30 S unit of ribosome thereby inhibiting protein synthesis
Bacteriostatic

30
Q

Tetracycline mechanism of resistance

A
  • Active against many gram positive and negative organisms but high rates of resistance (e.g. E.coli, S. Pneumoniae)
  • Creating enzymes, efflux pump
31
Q

Tetracycline coverage

A

DOC for rickettsiae, bartonella, chlamydiae and M pneumoniae

Nocardia, P acnes (mino usually), active against MRSA

32
Q

Tetracycline A/Es

A 
GI upset (N/V/D) most common
Skin rashes, photosensitivity, yeast overgrowth, deposits in bone, hepatitis

DIs: calcium, dairy, di-valent cations, antacids

33
Q

Glycylcyclines

A

Tigecycline (synthetic analogue)

Active against many things: MRSA, strep pneumoniae, enterococci, samonella, shigella, acinetobacter, anaerobes

34
Q

Glycopeptides and MOA

A

Vanco!
Inhibits cell wall peptidoglycan synthesis
Bacteriocidal

35
Q

Resistance of vancomycin

A

VRE, staph aureus, VISA (vanco intermediate staph aureus)

36
Q

Spectrum of vanco

A

Gram positive

  • Enterococci –> really hard to kill. If resistant to penicillin then use this
  • PRSP
  • MRSA
  • Clostridia
37
Q

When to use PO vanco

A

For C diff only

38
Q

A/E of Vanco

A

Nephrotoxicity, ototoxicity, red man syndrome (drop in BP, increase in HR, itch, fever, erythema), granulocytopenia

39
Q

Aminoglycosides and MOA

A

Streptomycin, gentamycin, tobramycin, amikacin
Inhibit protein synthesis by inhibiting 30S subunit of bacterial ribosome
Concentration dependent

40
Q

Similar drugs to vanco

A

Teicoplanin
Daptomycin
Means similar spectrum to vanco –> gram positive cocci

41
Q

AMG Resistance

A

Mutation or methylation of 16S rRNA binding site
Enzymatic destruction of the drug
Lack of permeability to the drug molecule
Active efflux (or lack of active transport)

42
Q

AMG Spectrum

A

Aerobic gram negative bacilli

  • Can be added to a penicillin and penetrate gram positive membrane
  • Synergistic with penicillins for enterococci and streptococci
  • Penetrates tissues poorly, no CNS
43
Q

A/E of AMGs

A

Nephrotoxicity (dose dependent, may be reversible) , ototoxicity (irreversible)

44
Q

Which ABX require TDM

A

AMGs, Vanco

45
Q

Quinolones and MOA

A

Cipro, levo, and moxifloxacin
Inhibit DNA gyrase or topoisomerase IV
Bacteriocidal

46
Q

Spectrum of FQs

A

Generally very broad spectrum
Gram negative bacilli, haemophilus sp, Neiserriae, Chlamyida
Cipro - most activity against P aeruingosa
Moxi - anaerobes
Levo - S pneumoniae

47
Q

FQs Resistance

A

Alteration of the A or B subunit of DNA gyrase (binding site)
Mutation in ParC or ParE of topoisomerase IV (where antibiotic binds)
Change in outer membrane permeability
Efflux pumps

48
Q

FQs uses

A 
Lots of RT infections (not cipro, reduced gram -ve activity)
UTIs (not moxi)
STIs
Travellers diarrhea
Drug resistant mycobacterial infections

Excellent oral bioF and should only be used for complex cases

49
Q

FQs A/E

A

Nausea, insomnia, headache, dizziness, seizures, skin rashes, impaired liver function, tendonitis, QT prolongation, dysglycemia, C diff

50
Q

FQs DI

A

Binding to di/tri valent cations which makes drug inactive, so no antacids, multivitamins, etc.
“Administer oral quinolones at least several hours before (4 h for moxifloxacin and 2 h for others) or after (8 h for moxifloxacin, 6 h for ciprofloxacin, 2 h for, levofloxacin) oral iron preparations. Monitor for diminished effects of the quinolone if this duration of dose separation cannot be achieved.”
QT prolonging drugs too

51
Q

Sulfa/Trim MOA!

A

SMX MOA – structural analogue of PABA (para-aminonezoic acid); competitively inhibits dihydrofolic acid synthesis
- Necessary for conversion of PABA to folic acid
TMP MOA- binds to dihydrofolate reductase therefore inhibiting the reduction of dihydrofolic acid to tetrahydrofolic acid
- Bacteria need to make their own folic acid to survive and in combo, these drugs block both mechanisms bacteria use to make folate

Synthetic! And bacteriostatic

52
Q

Resistance of Sulfa/Trim

A

ability of cells to use preformed folic acid

53
Q

Spectrum and Uses of Sulfa/Trim

A

Spectrum: Broad, Gram p, gram n, chlaymdiae, norcardiae, protozoa
Uses: UTI (trim alone!), SSTI (MRSA), PCP

54
Q

Sulfa/trim A/Es

A 
Skin rashes (SJS), hypersensitivity, GI, bone marrow suppression, hyperkalemia
Avoid in 1st trimester and in 3rd semester, sulfonamides can cause kernicterus in nerborns
55
Q

Metronidazole MOA and resistance

A

Unknown but possible inhibition of nucleic acid synthesis and disruption of DNA

Resistance is difficult to identify and unknown how much exists

56
Q

Metronidazole spectrum

A

Anaerobes including c diff
Protozoa, trichomonas (vaginal), giardia

Older drug that isn’t used much apparently, excellent bioF

57
Q

Metronidazole A/E

A

GI - common
Metallic taste - common
Headache - common
Dark urine
Peripheral neuropathy (long term, repeated courses of therapy)
Disulfram like reaction with alcohol which makes you feel sick af, counsel to avoid alcohol from 24 hours after last dose
Insomnia, stomatitis, mouth sores all rare

Pharmacy CPS Flashcards (27 decks)

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