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Pharmacology > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Antibiotics that TREAT Gram -

A

FQs (CIPRO)

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2
Q

Antibiotics that TREAT Gram +

A

Macrolides
Clindamycin

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3
Q

Antibiotics that TREAT BOTH Gram -/+

A

PCN
Cephalosporins
Sulfa
Beta-lactam inhibitors
FQs
Tetracycline

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4
Q

LOCATION: Heart

A

strep (GM +)
s.epi (GM +)

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5
Q

LOCATION: Abdominal

A

e coli (GM-)
enterococcus (GM +)
anaerobes
GM -

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6
Q

LOCATION: Brain

A

strep (GM +)
staph (GM +)
N. meningitides
e coli (GM -)

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7
Q

LOCATION: Respiratory

A

strep (GM +)
moraxella
H. flu
mycoplasma

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8
Q

LOCATION: Skin

A

staph (GM +)
strep (GM +)

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9
Q

LOCATION: GU

A

e coli (GM -)
enterococcus (GM +)

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10
Q

PCN MOA (-cillins)

A

inhibit CELL WALL SYNTHESIS

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11
Q

PCN Pharmacokinetic Profile

A

SE: Allergic RXN, Diarrhea, GI upset, Bacterial overgrowth w/ prolonged repeated treatment

Interactions: BIRTH CONTROL

Med Admin: RENAL function, 10-14 days treatment

Education: SAFE PREGNANCY, EMPTY STOMACH

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12
Q

Beta-Lactam/Beta-Lactam Inhibitors MOA

A

Inhibit CELL WALL synthesis

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13
Q

Beta-Lactam inhibitor Pharmacokinetic profile

A

SE: GI EFFECTS N/V/D

Contraindications: PCN allergy

Education: EXPENSIVE

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14
Q

Cephalosporins MOA

A

inhibit CELL WALL SYNTHESIS

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15
Q

Cephalosporins Pharmacokinetic profile

A

SE: GI (Diarrhea, C diff); Allergy (skin rash)

RISK of pseudomembranous colitis

Hypersensitivity = PCN allergy

Med administration: RENAL function w/ high doses; watch RBC, BUN, UA w/ prolonged treatment

Education: mostly PO, IM dose painful; well absorbed in GI; SAFE PREGNANCY; take w/ food

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16
Q

Fluoroquinolones MOA (-oxacins)

A

Ciprofloxacin, Gatifloxacin, Levofloxacin

inhibit NUCLEIC ACID synthesis

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17
Q

Fluoroquinolones Pharmacokinetic profile (-oxacins)

A

SE: QT prolongation, dizziness

Contraindications: NO PREGNANCY; AVOID peds/older adults = tendon rupture; AVOID Peds = interfere w/ growth plates

Interactions: NO milk, antacids, calcium, magnesium, iron, zinc

Med admin: DEC RENAL function will influence half life

Education: EMPTY STOMACH

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18
Q

Tetracyclines MOA (-cyclines)

A

inhibit PROTEIN SYNTHESIS

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19
Q

Tetracyclines Pharmacokinetic profile

A

Bacteriostatic = severe acne, Lyme disease, Rocky Mtn spotted fever

Contraindications: NO PREGNANCY; Caution w/ RENAL impairment

Interactions: NO antacids, dairy, calcium, iron, anticoagulants, digoxin, insulin, lithium, birth control, PCN

Education: Binds w/ calcium & developing teeth

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20
Q

Sulfonamides MOA (sulfa) (TMP-SMX)

A

Bactrim, Septra

Inhibit METABOLIC PATHWAYS

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21
Q

Sulfonamides Pharmacokinetic profile

A

SE: GI UPSET/Allergic Rxn = 1st degree sx; SJS; photosensitivity

NO PREGNANCY

Interactions: warfarin INC INR, phenytoin, sulfa drugs

Education: DRINK 1L daily (avoid crystallization), AVOID SUN

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22
Q

Clindamycin Class

A

Lincosamides

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23
Q

Clindamycin MOA

A

Inhibit PROTEIN SYNTHESIS

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24
Q

Clindamycin Pharmacokinetic Profile

A

Alternative agent for MRSA

TX: Mouth, Skin, Vagina

SE: GI upset, metallic taste; DIARRHEA

Med admin: MONITOR LIVER & KIDNEY

SAFE PREGNANCY

Education: LARGE glass of water, good for skin/bone

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25
Q

Metronidazole MOA

A

Flagyl

Disrupts DNA & PROTEIN SYNTHESIS

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26
Q

Metronidazole Pharmacokinetic Profile

A

SE: GI, HA, Dizziness, dry mouth, fatigue, metallic bitter taste

Contraindications: NO blood dycrasias, seizure d/o, neurological issues

NO ETOH

Interactions: cimetidine, phenobarbital, phenytoin

Med admin: topical form (local irritation)

SAFE PREGNANCY

TAKE W/ FOOD

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27
Q

Nitrofurantoin DOC

A

Macrodantin

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28
Q

Nitrofurantoin MOA

A

protein synthesis, aerobic energy metabolism, DNA synthesis, RNA synthesis, and cell wall synthesis are inhibited

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29
Q

Nitrofurantoin Efficacy

A

BacterioCIDAL = HIGH con

BacterioSTATIC = LOW con

30
Q

Nitrofurantoin Pharmacokinetic profile

A

SE: GI, SJS, HA, dizziness, may change urine color

NO ANTACIDS

DOC in PREGNANCY

Must complete 7 days of treatment

31
Q

Antimycobacterials MOA

A

inhibition of the cell wall synthesis

32
Q

Antimycobacterials Pharmacokinetic profile

A

Used to tx TB

33
Q

Antivirals classes

A

Nucleoside analogues
Influenza

34
Q

Antivirals (nucleoside analogues) MOA

A

Acyclovir, famciclovir, valacyclovir

Inhibit VIRAL CELL DNA SYNTHESIS

35
Q

Antivirals (nucleoside analogues) Pharmacokinetic profile

A

SE: HA, N/V/D, skin rash

INC risk of serious adverse effects in IMMUNOCOMPROMISED individuals

Interactions: FEW (probenecid, cimetidine, theophylline, digoxin)

Med admin: RENAL impairment = dosage change, START at earliest sign infection; PATIENT SELF INITIATE TX

SAFE PREGNANCY; SAFE CHILDREN OVER AGE 2

TAKEN W/FULL GLASS WATER

36
Q

Antivirals (influenza) MOA

A

Inhibit VIRAL CELL DNA SYNTHESIS

37
Q

Antivirals (influenza) Pharmacokinetic profile

A

Amantadine/Rimantadine (DEATH OVERDOSE) vs Zanamivir/Oseltamivir (MORE FREQUENT)

TX influenza

med admin: must be taken within 2 days of exposure or onset of sx

38
Q

Systemic Antifungals (-azoles) MOA

A

inhibit biosynthesis of ergosterol by interfering w/ the cytochrome P450

39
Q

Systemic Antifungals Pharmacokinetic profile

A

AZOLES

long term therapy = pulse dosing

many drug interactions

40
Q

Anti-fungal KETOCONAZOLE

A

Brand: Nizoral

Systemic - candidiasis, blastomycosis, histoplasmosis, dermatophytoses

BOX WARNING: hepatotoxicity, NEED LFTs before and during tx

DEC oral contraceptive effectiveness

monitor drug interactions

ADEs = pruritis and GI for oral, take with food

Pruritis, burning, drying, rash, hair loss with topical

separate oral from antacids

41
Q

Anti-fungal
FLUCONAZOLE

A

Brand: Diflucan (PO, IV)

NO PREGNANCY

Candidiasis- vaginal, oropharyngeal, esophageal, urinary, systemic

**CAUTION renal/hepatic impairment

multiple drug interactions - CYP450

Drugs that INC gastric pH will DEC absorption

Rifampin, histamine 2 blockers, warfarin

Terbinafine, ETOH = liver toxicity

ADEs = GI

42
Q

Anti-fungal
ITRACONAZOLE

A

Brand: Sporanox (capsules)
dermatophytoses, fungal keratitis, onchomycosis

oral and esophageal candidiasis

NO PREGNANCY

BOX WARNING: cardiovascular effects, no patients w/ LVD and HF

NO active liver disease

CHECK LFTs

ADEs = GI, edema, HA, HTN, abnormal LFT

NO grapefruit juice

43
Q

Anti-fungal
TERBINAFINE

A

Brand: Lamisil

NO PREGNANCY

onychomycosis of nails
tineas - pedis, cruris, corporis, versicolor

RARE = SJS, liver failure, SLE exacerbation

PO NOT for liver/renal impairment

oral ADEs = HA, fever, rash, GI

Topical - burning, dryness, exfoliation, irritation

HYGIENE IMPORTANT

44
Q

Blepharitis TREATMENT

A

warm compresses for 5-10 minutes 3-4x day

apply ERYTHROMYCIN OPHTHALMIC OINTMENT until sx clear + 7 more days

Ointment is preferred treatment d/t increased contact w/ ocular tissue

Azithromycin 1% solution for 4 wks may be used

45
Q

Conjunctivitis TREATMENT (bacterial, viral, allergic)

A

BACTERIAL - erythromycin ointment, fluoroquinolones

VIRAL - simple (sulfacetamide 10% solution, or broad spectrum); herpes keratitis (antiviral agents - ganciclovir, trifluridine, vidarabine)

ALLERGIC -

46
Q

Chronic Bronchitis TREATMENT

A

sulfonamides

amoxicillin

47
Q

Community Acquired Pneumonia CAUSES

A

strep pneumoniae

48
Q

Community Acquired Pneumonia MICROORGANISMS

A

STREP PNEUMONIAE (PNEUMOCOCCUS)

Common = haemaphilus influenzae, moraxella catarrhalis

viruses

**most cases causative organism is never identified&raquo_space; EMPIRIC COVERAGE

49
Q

Community Acquired Pneumonia TREATMENT

A

Healthy outpatient = MACROLIDE (AZITHROMYCIN) or doxycycline

Outpatient w/ comorbidity = RESP FQ (2nd gen or higher) or BETA-LACTAM (amoxicillin or augmentin) + MACROLIDE

FQ: NO CIPRO (1st gen)

Pregnancy = tx as healthy outpatient. ERYTHROMYCIN or AZITHROMYCIN 1ST CHOICE

50
Q

STI: SYPHILIS

A

DOC: BENZATHINE PCN (bicillin-LA)
Pregnancy DOC: BENZATHINE PCN
PCN allergy: desensitize and give BENZATHINE PCN

DOSES:
Primary/Secondary syphilis:
Adults: 2.4 million units IM single dose

infants/children: 50,000 units/kg IM single dose

LATE LATENT: same dose, but given 3 times, 1 wk apart (ADULT total 7.2 million units, CHILDREN total 150,000 units/kg)

51
Q

STI: GONORRHEA

A

develops resistance to antimicrobials easily

DOC: CEPHALOSPORINS

RECOMMENDED TX: cephalosporins + azithromycin or doxycycline

DOSAGE: Ceftriaxone 250mg IM single dose + Azithromycin 1g orally single dose

52
Q

STI: CHLAMYDIA

A

DOSAGE: AZITHROMYCIN 1mg orally single dose OR DOXYCYCLINE 100mg BID x7 days

PREGNANCY: AZITHROMYCIN 1g orally single dose

INFANTS/CHILDREN:
weight >45kg and age <8 yrs: azithromycin 1g PO single dose

Age >8 yrs: azithromycin 1g PO single dose OR doxycycline 100mg PO BID x7 days

53
Q

STI: HERPES

A

USE ANTIVIRALS

FIRST EPISODE: ACYCLOVIR 400mg PO TID x7-10 days OR VALACYCLOVIR 1g PO BID x7-10 days

RECURRENT HERPES: ACYCLOVIR 400mg PO TID x5 days

PREGNANCY: start at 36 wks; ACYCLOVIR 400mg PO TID OR VALACYCLOVIR 500mg PO BID

54
Q

Vaginitis: BACTERIAL VAGINOSIS

A

fried egg cells w/ pepper

DOC: METRONIDAZOLE 500mg PO BID x7 days; Clindamycin cream 2% 5g vaginally x7 days; Metronidazole gel 0.75% one applicator vaginally x5 days

PREGNANCY: METRONIDAZOLE 500mg BID x7 days

pregnancy ONLY PO MEDS

55
Q

Vaginitis: TRICHOMONIASIS

A

protozoan infection

DOC: METRONIDAZOLE 2g PO single dose OR tinidazole 2g PO single dose OR metronidazole 500mg BID x7 days

TREAT PARTNERS

PREGNANCY: use METRONIDAZOLE (risk of preterm labor, PROM, LBW)

56
Q

Vaginitis: VULVOVAGINAL CANDIDIASIS

A

recent hx antibiotic use

chronic infections: screen for DM

DOC: FLUCONAZOLE 150mg PO single dose

PREGNANCY: ONLY TOPICAL CREAM

CAUTION: AZOLE DRUG INTERACTIONS

57
Q

Otitis TYPES

A

Serous Otitis - chronic, viral

Otitis Media - bacterial

Otitis externa

58
Q

Otitis CAUSES

A

Bacteria:
GM + STREP

GM - HAEMOPHILIUS INFLUENZA, MORAXELLA CATARAHALIS

59
Q

Otitis PATHO

A

Viral URTI &raquo_space; microbes refluxed into middle ear&raquo_space; dark warn moist place&raquo_space; bacteria enters (squatter)&raquo_space; bacterial infection (AOM)

60
Q

AOM Observational therapy

A

LOW RISK CASES: watchful waiting, pain management, no longer than 48-72 hrs

61
Q

AOM TREATMENT

A

Based on severity
FIRST LINE: AMOXICILLIN OR ERYTHROMYCIN (IF PCN ALLERGY)

If resistance suspected = broad spectrum beta-lactam resistant CEPHALOSPORIN or combo (amoxicillin/clavulanate, TMP-SMX)

No response within 48 hrs = change antibiotic therapy

62
Q

Rhinosinusitis TREATMENT

A

first line = amoxicillin/clavulanate

treat 5-7 days in adults, 10-14 days in children

other therapy: RECOMMEND
saline irrigation (Nettie pots)
INTRANASAL CORTICOSTEROIDS

63
Q

First vs Second line therapy RHINOSINUSITIS

A

FIRST LINE = AMOXICILLIN/CLAVULANATE; PCN allergy: doxycycline or resp FQ

SECOND LINE = RESP FQ (NOT CIPRO = 1st gen) use 2nd gen or higher

64
Q

Complicated UTI

A

recurrent UTI
pregnancy
pediatric patient to age 18
co-morbidities
post-menopausal
recent hospital discharge or resident of LTC
Men
s/sx of pyelonephritis

65
Q

Uncomplicated UTI

A

healthy woman, NOT pregnant

66
Q

UTI DOC

A

UNCOMPLICATED UTI:
DOC: NITROFURANTOIN 100mg BID x5 days

TMP-SMX DS 1 BID x3 days (increasing resistance)

Other: FQs 3 day regimen

COMPLICATED UTI: SAME AS ABOVE, tx 7-14 days

DOC: NITROFURATOIN 100mg BID x7 days
NO SULFA/FQs

test for cure: urine culture/sensitivity 1 wk after tx

67
Q

URINARY ANALGESIC DRUGS

A

primary ingredient in these products is phenazopyridine

Brands: Azo-standard, Prodium, Pyridium, Uricalm, Urogesic

patient can take phenazopyridine 200mg x3 day for 2 days as a urinary analgesic added to treatment regimen

68
Q

Pharmacokinetics vs pharmacodynamics in PEDs

A

PHARMACOKINETICS –

PHARMACODYNAMICS –

69
Q

Developmental aspects of PED med administration

A

BREASTFED INFANTS – drug excretion in breastmilk

INFANTS– teaching parents how to administer meds; discuss reason for med, dose, how to draw up med, length of tx, potential adverse effects; dosing meds for parental convenience INC compliance

TODDLERS/PRESCHOOLERS – discuss med admin w/ parent before prescribing; chewable formulation if possible; prescribe a once or twice daily med if possible

SCHOOL-AGE – include child in decision making process; let child choose formulation; be sure child can swallow pills; teaching should be aimed at both child and parent

ADOLESCENTS – administer own meds; compliance rates vary

70
Q

Factors that influence + outcomes in medication adherence in PED patients

A

SPECIFIC FACTORS – long-term med regimens, number of meds prescribed, med interval, palatability, cost, family issues

IMPROVE COMPLIANCE – med concentration (liquid form), written vs oral instructions, self-monitoring calendars, telephone/email reminders, mobile phone med adherence apps, med admin at school, contracts/reinforcement programs

CHILDHOOD OBESITY – no guidelines; monitor patient closely for adverse effect if dosed by weight, efficacy if dosed by age

Pharmacology (12 decks)

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