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Pharm Module 3 antibiotics > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

What is empiric therapy

A

treatment prior to the identity of the organism

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2
Q

When is empiric therapy indicated

A

In critically ill patients

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3
Q

What type of treatment is given for empiric therapy

A

Broad spectrum

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4
Q

What is antibiotic sensitivity consideration based on

A

Pattern of antibiotic sensitivity

Lab testing

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5
Q

What is MIC

A

Lowest concentration of a drug that inhibits bacterial growth (minimal inhibitory concentration)

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6
Q

What is MBC

A

Minimal bactericidal concentration

Lowest concentration of a drug that kills bacteria

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7
Q

How do bacteriostatic antibiotics work

A

They inhibit bacterial replication but does not kill bacteria

Host defenses required

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8
Q

What are some miscellaneous considerations to include when choosing an antibiotic

A

Route of administration

Tissue distribution

Route of metabolism/ elimination

Side effects/ toxicity

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9
Q

What are the host specific considerations to have while choosing an antibiotic

A

Immune status
Anatomy
allergies
Bioavailability
Other drug interactions
age
pregnancy
renal function

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10
Q

Why do you have to consider immune status before giving an antibiotic

A

Are they neutropenic
Do they have cell mediated defects

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11
Q

What type of antibiotic would you give someone with a compromised immune system

A

bactericidal

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12
Q

Why do you consider the anatomy before giving an antibiotic

A

Do they have an abcess, necrotic tissue, foreign material

Need to match the drug bioavailability to the site of infection

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13
Q

What type of drug would you give for an immune protected area

A

Bactericidal

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14
Q

What are some immune protected areas

A

CNS
Eye
Bacterial endocarditis

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15
Q

Why is renal function important to consider before administering an antibiotic

A

Some drugs need to be dose adjusted because the kidney filters them

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16
Q

Why is age important to consider before prescribing antibiotics

A

You should avoid chloramphenicol and sulfonamides in neonates

avoid tetracyclines in small children

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17
Q

What type of antibiotic would you avoid prescribing during pregnancy

A

Aminoglycosides

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18
Q

Which antibiotics are poorly absorbed in the GI tract and thus require IV admin instead of oral

A

Vancomycin and aminoglycosides

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19
Q

What is synergy

A

When the combined effect of two antibiotics is greater than if they were given alone

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20
Q

What is antagonism

A

When the combined effect of two antibiotics is worse than if given alone

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21
Q

What is indifference

A

When the effect of 2 antibiotics equals that of their independent activity

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22
Q

B-lactam combined with aminoglycosides against gram negative bacteria is an example of what type of interaction

A

Synergistic

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23
Q

Penicillin (Bactericidal against susceptible forms of strep pneumoniae) combined with tetracycline (Bactericidal) would give what type of effect

A

Antagonistic

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24
Q

What are some examples for antibiotic prophylaxis

A

prior to surgery
Pre dental extractions
Prevention of TB / meningitis
PJP in HIV infected patients
Recurrent UTI

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25
Q

Which antibiotics require dose adjustment in renal insufficiency

A

Penicillin
Amoxicillin
Piperacillin/ Tazobactam (Zosyn)
Cephalexin
Cefuroxime
Ciprofloxacin
Levofloxacine
Trimethoprim
Clarithromycin

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26
Q

Where are the common mechanism of action sites

A

Cell wall synthesis
Folic acid metabolism
Periplasmic space
Cell membrane
Protein synthesis
DNA gyrase
DNA directed RNA polymerase

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27
Q

What are the different types of protein synthesis in which antibiotics can have an effect

A

tRNA
30s inhibitors
50s inhibitors

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28
Q

What types of drugs are cell wall synthesis inhibitors

A

Penicillins
Monobactam
carbapenems
Combo agents
Cephalosporins
Glycopeptides

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29
Q

What is the mechanism of action for B-lactam antibiotics

A

Interfere with cell wall synthesis by binding to penicillin binding proteins.

This compromises the cell wall integrity = cell lysis

Enhances cell breakdown by activating autolytic enzymes

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30
Q

What are penicillin binding proteins

A

Transpeptidase enzymes that catalyze cross-linking of peptidoglycans

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31
Q

What is penicillin made up of

A

Thiazolidine
B-lactam ring
Side chain

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32
Q

What does the B lactate ring do

A

Essential for antibacterial activity

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33
Q

What does the side chain in penicillin do

A

Determines the antibacterial spectrum and pharmacologic properties of a particular penicillin

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34
Q

What are the classifications of penicillin

A

Natural
Aminopenicillin
Semi-synthetic
Ureidopenicillin
Beta lactamase inhibitor

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35
Q

What type of penicillin is considered natural

A

Penicillin G
Penicillin V

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36
Q

Which forms of penicillin are penicillinase sensitive

A

Natural
Aminopenicillin

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37
Q

What forms of penicillin make up the aminopenicillins

A

Ampicillin
Amoxicillin

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38
Q

What makes up the semi-synthetic penicillin

A

Nafcillin
oxacillin
Dicloxacillin

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39
Q

What types of penicillin are penicillinase resistant

A

Semi synthetic

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40
Q

What makes up ureidopenicillinl

A

piperacillin
Ticarcillin

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41
Q

How is piperacillin used

A

Never alone, always needs a b-lactam inhibitor

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42
Q

what type of penicillin treat gram positive cocci

A

Penicillin G, V

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43
Q

What pathogens are considered gram positive cocci

A

Strep pneumoniae
Group A strep (S. pyogenes)
Group B strep (S. agalactiae)
Group C,G strep
Viridans strep

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44
Q

What does Strep pneumoniae cause

A

Sinusitis
otitis media
Pneumonia
meningitis

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45
Q

What does group A strep cause

A

Bacterial pharyngitis
Cellulitis
toxic shock
Necrotizing fasciitis

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46
Q

What does group C,G strep cause

A

Cellulitis
Skin/soft tissue infections

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47
Q

What does group B strep cause

A

Meningitis in newborns
Bacteremia in elderly / diabetics

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48
Q

What pathogen does penicillin G,V not cover

A

Staph

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49
Q

What is penicillin V typically used for

A

Generally for group A strep (Strep throat)

Generally in kids or anyone with a doxycycline allergy

Syphillis

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50
Q

What type of gram negative cocci does natural penicillin treat

A

Neisseria meningitidis (Meningitis and bacteremia)

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51
Q

Why is natural penicillin not useful to treat N. Gonorrhoeae

A

Because of the widespread presence of penicillinase

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52
Q

What are the pharmokinetics for Penicillin V and G

A

Penicillin V = oral
Penicillin G = IV/IM

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53
Q

Why is penicillin not a good agent against bactericides fragilis and other bactericides spp?

A

Because of the presence of beta-lactamase

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54
Q

What is Natural penicillin’s spectrum of activity for spirochetes

A

Works against
treponema pallidum (Syphilis)

Borrelia burgdorferi (Not typically used to treat Lyme though)

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55
Q

Why does penicillin G require frequent dosing when prescribed

A

Because of its 1/2hour half life

56
Q

Which natural penicillin has better oral bioavailability

A

Penicillin V

57
Q

If a patient requires an IM penicillin G administration, what is important to remember

A

That it cannot be given alone when given via IV

58
Q

What is the most common side effect from Penicillin

A

Rash

59
Q

What are the side effects of penicillin

A

Rash
Seizures
Anaphylaxis

60
Q

When are patients at a high risk for seizures with penicillin

A

When a patient has a seizure disorder OR when a high dose of Pen G is given to someone with renal insufficiency

61
Q

What is a contraindication for natural penicillin

A

Hypersensitivity to B-lactams antibiotics

Use with caution in patients with asthma or with a hx of multiple allergens

62
Q

Which organism is penicillin resistant and why

A

S.aureus

Contains a penicillinase which hydrolyzes the beta lactase ring

63
Q

If a patient has a suspected S. aureus infection- which antibiotic should NOT be used

A

Natural penicillin and Aminopenicillin

64
Q

What is methicillin

A

The first penicillin developed to resist hydrolysis by staph beta-lactamase

65
Q

What is methicillin used for

A

Treatment of infections caused by penicillinase-producing staph

66
Q

Which type of penicillin is more useful against strep A, Strep B, and strep pneumonia

A

Penicillin G

67
Q

What organism is semi-synthetic penicillin not useful against

A

Gram - activity

68
Q

What is the IV/IM form of semi-synthetic penicillin

A

Nafcillin and oxacillin

69
Q

What is the PO form of semi-synthetic penicillin

A

Dicloxacillin

70
Q

Which semi-synthetic penicillin do not require renal or hepatic dosing adjustments

A

Dicloxacillin

Oxacillin

71
Q

If a patient comes in with an MSSA infection… what would be the best type of penicillin to treat it with

A

Oxacillin or nafcillin

72
Q

If a patient comes in with elevated creatinine, fever, and peripheral eosinophilia, what is their likely diagnosis

A

Allergic interstitial nephritis

73
Q

What causes neutropenia with oxacillin/nafcillin dosing and when is it seen

A

Occurs 3 wks after a high dose therapy and is treated by decreasing the dose

74
Q

Which antibiotic is 2x more active against enterococci than penicillin

A

Ampicillin or amoxicillin

75
Q

If a patient comes in with listeria monocytogenes, what would be the antibiotic used to treat

A

Ampicillin or amoxicillin

76
Q

What is the cause of meningitis in immunosuppressed patients, newborns, and individuals over 50

A

Listeria monocytogenes (Aminopenicillin better to treat than natural penicillin)

77
Q

What is ampicillin/amoxicillin spectrum of activity against gram positive cocci

A

Active agent against penicillin-susceptible s. aureus

Not useful for most S.aureus though because of the beta-lactamase ring

78
Q

What kind of gram - bacteria do ampicillin/amoxicillin treat

A

H. Influenzae
E. coli
*~40% resistant due to beta-lactamase

79
Q

What are the common side effects of ampicillin and amoxicillin

A

Rash (4-8%)
Diarrhea (2-5%)
- worse is ampicillin

80
Q

If a patient is given amoxicillin when they have infectious mononucleosis, what is the likely reaction going to be

A

Erythematous rash

81
Q

What happens to the spectrum of activity if you combine B-lactamase inhibitors

A

Increase

82
Q

When is IV ampicillin-sulbactam used (unasyn)

A

MSSA (gram+)
H. influenza , E.coli, K. Pneumonia (Gram -)
Bacteroides Fragilis (Anaerobe)

83
Q

When is PO amoxicillin-clavulanate used (Augmentin)

A

MSSA (gram+)
H. influenza , E.coli, K. Pneumonia (Gram -)
Bacteroides Fragilis (Anaerobe)

84
Q

What do beta-lactamase inhibitors treat better than ampicillin/amoxicillin

A

Better gram negative activity

85
Q

What are the narrow-spectrum b-lactamase susceptible agents

A

Sreptococci
enterococci
Anaerobes

86
Q

What are the very narrow spectrum B-lactamase resistant agents

A

S.Aureus, s epidermidis, streptococci

87
Q

What type of drug is cephalosporin

A

Bactericidal

88
Q

How is cephalosporin different from penicillin

A

Resistant to hydrolysis by beta-lactamase

R1&R2 side chain substitutions alter antibacterial spectrum and pharmokinetics

89
Q

How are cephalosporins classified

A

By generation in order of their development

90
Q

How does cephalosporin change with each generation

A

Increase gram negative activity with loss of gram positive activity

91
Q

Why does cephalosporin have greater resistance to b-lactamases than penicillin

A

Because cephalosporin has a 6-membered ring (Larger than penicillin)

92
Q

What are some adverse reactions for cephalosporin

A

Hypersensitivity
Superinfections

93
Q

What is the mechanism of action for cephalosporin

A

Inhibits bacterial cell wall synthesis

94
Q

How is ceftriaxone administered

A

IV

95
Q

Which forms of Cephalosporin is administered via IV therapy

A

Ceftriaxone
Cefepime
Ceftaroline
Ceftazidime
cafazolin

96
Q

If a person came in and was diagnosed with MRSA, what could you give as a treatment

A

Vancomycin

97
Q

How is aztreonam administered

A

IV/IM

98
Q

What class of drug is aztreonam

A

Monobactam

Broad gram- activity including pseudomonas aeruginosa

99
Q

What is the mechanism of action for aztreonam

A

Prevents peptidoglycan cross-linking by binding to PBP3

100
Q

What can aztreonam be given as an alternative to

A

Aminoglycosides and 3rd generation cephalosporin

101
Q

What type of pathogen does aztreonam NOT work against

A

gram + or anaerobic activity

102
Q

What type of antibiotic is vancomycin

A

Non b-lactam

glycopeptide

bactericidal

103
Q

What is the mechanism of action for vancomycin

A

Inhibits cell wall synthesis by binding the D-Ala-D-Ala terminal of the forming glycopeptide which prevents cross linking

104
Q

When is vancomycin used

A

When there is a drug resistant gram + infection (MRSA and C.Diff)

105
Q

What type of infection is vancomycin not helpful against

A

Gram negative activity

106
Q

What are the side effects of vancomycin

A

Infusion related flushing (Red man syndrome)
Ototoxicity / nephrotoxicity

107
Q

What is red man syndrome

A

Infusion related flushing

108
Q

When are you more likely to get ototoxicity or nephrotoxicity with vancomycin

A

At higher doses or in the presence of other toxic drugs

109
Q

Which type of infection of vancomycin resistant

A

VRE and VRSA

110
Q

What is the drug of choice against MRSA

A

Vancomycin

111
Q

What type of antibiotic is daptomycin

A

Lipopeptide

Bactericidal

112
Q

How is daptomycin administered

A

IV only

113
Q

Is daptomycin a broad spectrum or narrow spectrum antibiotic

A

Narrow

114
Q

When is daptomycin a useful treatment

A

With resistant gram positive cocci
-VRE
-MRSA

115
Q

What is a primary toxicity associated with daptomycin

A

Myositis (Myopathy, muscle pain)

116
Q

What are carbapenems

A

Structure of the b-lactam ring that is highly resistant to B-lactamases

117
Q

What is one of the broadest spectrum antibacterial agents on the market

A

carbapenems

118
Q

What are carbapenems useful against

A

Gram positive cocci (MSSA, MSSE, S. Pneumonia)
Gram - rod and resistan gram- rods
Anaerobes

119
Q

An increased expression of AmpC gene is regulated by presence of substrates like what?

A

3rd generation cephalosporin and other genes

120
Q

What are the SPACE organisms

A

Serratia marcescens
Proteus spp
Acinetobacter baumannii
Citrobacter Freundii
Enterobacter spp

121
Q

What does ESBL stand for

A

Extended spectrum b-lactamases

122
Q

What are ESBL organisms

A

TEM-1
Allow for drug resistance against Beta lactams

123
Q

Which bacteria are ESBL found on

A

E.coli and klebsiella

124
Q

What drug is typically needed against an ESBL

A

> 3rd generation cephalosporin

125
Q

What are 3 types of carbapenems

A

Imipenem
Meropenem
Ertapenem

126
Q

Which carbapenem is most toxic

A

Imipenem

127
Q

What is imipenem inactivated by and what are common side effects

A

Renal dehydropeptidase

Encephalopathy and seizures

128
Q

What does imipenem need to be given with to inhibit DHP

A

cilastatin

129
Q

What is the difference between imipenem and meropenem

A

Meropenem is not inactivated by DHP and is less likely to cause seizures

130
Q

What kind of gram + organisms that can be treated by carbapenems

A

MSSA
MSSE

131
Q

What is the spectrum of activity of carbapenems against gram negative organisms

A

Enterobacteriaceae (Excellent activity against)
Good ESBL
Pseudomonas

132
Q

What type of drug is fosfomycin

A

Bactericidal

133
Q

What is the mechanism of action of fosfomycin

A

Inhibit the first step of bacterial cell wall synthesis by inhibiting pyruvyl transferase

134
Q

When is fosfomycin typically used

A

Treatment of UTIs

particularly those caused by E. coli and enterococcus faecalis

135
Q

What are the side effect of fosfomycin

A

Diarrhea
vaginitis

136
Q

What is the mechanism of action for Daptomycin

A

It alters the curvature of the cell membrane which leads to holes and leaks, completely disrupting the cell membrane

137
Q

How is Fosfomycin administered

A

One time oral dose

Pharm Module 3 antibiotics (2 decks)

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