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Antibiotics Flashcards

1
Q

What are the beta lactam classes?

A

Penicillins
Cephalosporins
Carbapenems
Monobactams

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2
Q

What is the beta lactam MOA?

A

Beta lactam ring binds to transpeptidase which inhibits bacterial wall synthesis. They can also bind to transpeptidase and cause bacterial autolytic enzymes to be relases and cause cell lysis.

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3
Q

How do bacteria fight against beta lactams?

A

Beta lactamases
Reduce binding affinity to transpeptidase/PBP
Over production of PBP
Loss of membrane porins
Expression of efflux pumps

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4
Q

What bacteria can natural penicillins be used against?

A

Gram + (s pneumoniae, staph, b anthrax, anaerobes)
Gram - (n meningitides)
Spirochetes (treponema pallidum/syphylis)
NO MRSA

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5
Q

What is natural penicillin a first line treatment for?

A

Strep Throat -GABHS
Syphilis
Cellulitis
Meningitis

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6
Q

What are the natural penicillins?

A

PCN G
PCN V

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7
Q

What are the antistaphylococcal PCNs?

A

Dicloxacillin
Nafcillin
Oxacillin

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8
Q

When can antistaphylococcal PCNs be used?

A

Only skin and soft tissue infections
s aureus and s epidermis
NO MRSA coverage

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9
Q

What are the aminopenicillins?

A

Amoxicillin and ampicillin

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10
Q

What are first line uses for aminopenicillins?

A

Otitis media (amoxicillin)
Endocarditis prophylaxis

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11
Q

What are the most common causes of otitis media?

A

S pneumoniae
M catarrhailis
H influenza

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12
Q

What are the advantages of an aminopenicillin over a natural penicillin?

A

Better oral absorption, longer half life, better gram negative penetration

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13
Q

What are the PCN/Beta lactamase inhibitor drugs?

A

Amoxicillin/Clavulanic acid (amoxicillin)
Ampicillin/sulbactam (Unasyn)

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14
Q

What does the addition of the BLI do to the susceptibility profile of a PCN/BLI?

A

Better staph coverage
Overcomes BL resistance
Extends spectrum of activity

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15
Q

What are the first line uses for PCN/BLI?

A

Sinusitis, PNA, COPD exacerbations
S pneumo, H flu, S aureus

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16
Q

Why not just use a PCN/BLI on everyone?

A

Increased cost
more GI effects
More severe/refractory infections only

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17
Q

What are the extended spectrum penicillins/antipseudomonal penicillins?

A

Piperacillin/tazobactam (Zosyn)

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18
Q

What does the extended spectrum penicillins cover that other PCNs do not?

A

Pseudomonas and proteus

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19
Q

When do you chose a extended spectrum penicillin?

A

UTI
Peritonitis
Skin/soft tissue
Lower respiratory tract
Septicemia

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20
Q

What is the mechanism of action for cephalosporins?

A

Beta lactam ring binds to transpeptidase which inhibits bacterial wall synthesis. They can also bind to transpeptidase and cause bacterial autolytic enzymes to be released and cause cell lysis.

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21
Q

What is the difference between cephalosporin generations?

A

Increasing generations increases Gram - coverage at the cost of gram + coverage

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22
Q

What are the 1st generation cephalosporins?

A

cephalexin (Keflex)
cefazolin (Ancef)
cefadroxil (Duricef, Ultracef

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23
Q

What bacteria do you use Keflex against?

A

Staph, strep, E coli

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24
Q

What are common indications for Keflex?

A

Skin infections
Impetigo
Pharyngitis/otitis media
Cystitis (esp pregnancy)

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25
What are common indications for Ancef (cefazolin)?
Surgical prophylaxis Serious MSSA infections (endocarditis, PNA, UTI) (cause IM/IV only)
26
What are common indications for cefadroxil (Duricef, Ultracef)
Pharyngitis/tonsillitis Advantage is that it is taken BID
27
What are the 2nd generation cephalosporins?
Cefuroxime Cefoxitin Cefotetan Cefaclor Cefprozil
28
What are the indications for cefoxitin/cefotetan?
surgical prophylaxis for dirty procedures
29
What are the indications for cefuroxime/cefaclor/cefprozil?
2nd line for pharyngitis, sinusitis, OM, upper and lower respiratory tract infections
30
What are the 3rd generation cephalosporins?
Ceftriaxone (Rocephin) Cefdinir (Omnicef) Cefixime (Suprax)
31
What are the indications for ceftriaxone (Rocephin)?
1st line for Neisseria gonorrhoeae Good for pneumococcals Open abdominal prophylaxis Meningitis PID
32
What are the indications for cefdinir (Omnicef) and Cefixime (Suprax)?
2nd line for upper and lower respiratory infections Skin and soft tissue infections
33
What is the 4th generation cephalosporin?
Cefepime (Macipime)
34
What is the spectrum of cefepime?
Gram +, gram -, and pseudomonas
35
When do you use cefepime?
Severe infections Meningitis (bc penetrates CSF) SAVE THIS DRUG
36
What is the 5th generation cephalosporin?
Cetaroline
37
What is the spectrum of coverage for ceftaroline?
Gram + MRSA VRE
38
Which generations of cephalosporins penetrate the CNS?
3 and 4 do well 5 does a little
39
What is the monobactam?
Aztreonam (Azactam)
40
What generation cephalosporin are monobactams closest to?
3rd/4th generation
41
What is the susceptibility of aztreonam?
Gram - Pseudomonas No gram + or anaerobes
42
When do you use aztreonam?
Severe UTIs (E coli) Bacteremia/Sepsis Inhalation (for CF respiratory infections)
43
What are the carbapenems?
Imipenem/cilastatin Meropenem Ertapenem Doripenem
44
What is the susceptibility of carbapenems?
Very broad spectrum Gram + Gram - Anaerobes Pseudomonas NO MRSA
45
When to use a carbapenem?
Severe infections only UTI Meningitis Peritonitis/intra abd infections Resistant wounds (chronic diabetic) Osteomylitis
46
What are the common side effects of beta lactams?
GI (N/V/D) Vaginal candidiasis
47
What are adverse events for beta lactams?
Hypersensitivity C dif Nephritis Anemia, thrombocytopenia CNS toxicity
48
How many people claim to be allergic to PCNs? How many are actually allergic?
10%, <1%
49
How are beta lactams metabolized? Excreted?
hepatic metabolism and renal secretion
50
What monitoring should you do for beta lactams?
CBC with prolonged treatment for neutopenia Kidney function for prolonged treatment
51
What pregnancy category are beta lactams?
B
52
What are the drug interactions of beta-lactams?
Decrease the effectiveness of oral contraceptives
53
What drug is a glycopeptide?
Vancomycin
54
What is the MOA of vancomycin?
Binds to D-ala D-ala in the peptidoglycan preventing the formation of peptidoglycan and phospholipids, this weakens the cell wall and inhibits replication
55
How can bacteria be resistant to vancomycin?
Bacteria alter the binding site to D-ala D-lac so vanc cannot bind. Seen in VRE.
56
What is the spectrum of vancomycin?
Gram + cocci and bacilli Specifically MRSA and C diff
57
What are the indications for vancomycin?
MRSA Severe C dif
58
How is vanc metabolized and excreted?
Not metabolized but is renally excreted, must adjust for renal impairment
59
What is the pregnancy category for vancomycin?
B for oral and C for IV Must do benefit risk assessment
60
What does vancomycin dosing rely on?
Body weight and CrCl, Has narrow therapeutic window that needs to be monitored via trough levels or AUC (MRSA) 30 minutes before and 1-2h after each dose
61
When is steady state of vanc reached?
4th dose in normal renal concentration
62
What are the adverse effects of vancomycin?
Red man syndrome Nephrotoxicity Ototoxicity
63
What drugs are aminoglycosides?
Gentamicin Tobramycin Amikacin Streptomycin
64
What is the MOA of aminoglycosides?
Bind to the 30s subunit which inhibits bacterial protein synthesis which is bacteriostatic. They suppress bacterial growth for a little after stopping ABx.
65
How do aminoglycosides gain resistance?
Chromosomal mutation of 30s Enzymatic destruction of ABx Lack of permeability through cell wall Efflux pumps
66
What is the spectrum of aminoglycosides?
Gram - Mycobacterium tuberculosis (Atypical) NO Gram +
67
What are the BBW for aminoglycosides?
Ototoxicity Nephrotoxicity Neuromuscular paralysis
68
Which aminoglycoside is topical?
Neomycin
69
Which aminoglycoside is a ophthalmic drop?
Tobramycin
70
What are aminoglycosides most commonly paired with?
A PCN such as ampicillin + Gentamycin to make a broad spectrum therapy
71
What pregnancy category are aminoglycosides?
D for do not use
72
What is dosing of aminoglycosides based off of?
Weight and renal function, monitor peak and trough levels
73
What monitoring needs to be done with aminoglycosides?
BUN/Cr Audiometry for long term, high doses
74
What drugs are tetracyclines?
Tetracycline Doxycycline Minocycline
75
What is the MOA of tetracycline?
Bind 30S ribosomal subunit and block tRNA binding (bateriostatic)
76
How to bacteria resist tetracyclines?
Efflux pumps Enzyme deactivation
77
What is the spectrum of activity of tetracyclines?
Gram + Gram - MRSA Atypicals (Mycoplasma, Rickettsiae, Chlamydiae, Spirochetes)
78
What are the first line indications for tetracyclines?
Lyme Disease Rocky Mountain Spotted Fever Cholera Acne Chlamydia CAP
79
What are the contraindications for tetracyclines?
Children <8-9 years old, <13 is not preferred Pregnancy and nursing
80
What is the metabolism of tetracyclines?
Metabolized in liver and excreted via urine and bile
81
What should tetracycline not be taken with?
TUMS/antacids
82
What are the adverse effects of tetracyclines?
GI distress Hepatotoxicity Photosensitivity Vertigo Candida infections C diff
83
What drugs are macrolides?
Azithromycin (Zithromax) Erythromycin Clarithromycin
84
What is the MOA of macrolides?
Inhibits protein synthesis and translocation needed to replicate by binding to the 50S subunit
85
How do macrolides gain resistance?
50s subunit target modification Efflux pumps Degradation enzymes
86
What is the spectrum of activity of macrolides?
Gram + Gram - Atypicals
87
What are first line indications for macrolides?
CAP Chlamydia Legionella Diphtheria COPD (2nd line OM, pharyngitis)
88
Can you use z-pack for sinusitis?
No. Use augmentin
89
Which has broader coverage of the macrolides?
azithromycin (also the only IV one)
90
What is the metabolism and excretion of macrolides?
Metabolized by liver, eliminated in bile, caution with liver impairment
91
What are the adverse effects of macrolides?
GI, N/D and C diff Hepatotoxicity Prolonged QT interval Ototoxicity
92
What pregnancy category are macrolides?
Preg B
93
What is the MOA of clindamycin?
Same as macrolides, Inhibits protein synthesis and translocation needed to replicate by binding to the 50S subunit
94
What is the spectrum of activity for clindamycin?
Gram + MRSA (some strains) Anaerobes
95
What are indications for clindamycin?
Oral abscesses Endocarditis prophylaxis Bacterial Vaginosis MRSA skin/soft tissue infections
96
What are the side effects of clindamycin?
Diarrhea, nausea skin rashes
97
What is the BBW for clindamycin?
C diff
98
What pregnancy category is clindamycin?
B
99
What drugs are quinolones?
Ciprofloxacin Levofloxacin Moxifloxacin
100
What is the MOA of quinolones?
Inhibition of DNA gyrase and topoisomerase causes rapid bactericidal activity
101
How do bacteria resist quinolones?
Mutation in chromosomal genes of gyrase and topoisomerase Efflux pump Decreased cell wall permeability
102
What is the spectrum of activity of quinolones?
Gram - > gram + Moxifloxacin also has anaerobic
103
When is cipro used vs Levo and moxi?
Cipro is belly button down Levo/Moxi are belly button up
104
What are the first line indications for quinolones?
Otitis external (C/L) Opthalmic infections (C/L) Pyelonephritis (C) Prostatitis (C) Traveller's diarrhea (C) Anthrax (C) URI/PNA with comorbidities (L/M)
105
What is the metabolism of quinolones?
Liver metabolism and urine/feces excretion
106
What are the contraindications for quinolones?
Prolonged QT/arrhythmias Myasthenia Gravis
107
Can you use quinolones in kids?
Yes if necessary but not first line
108
What is the pregnancy rating of quinolones?
C
109
What is the BBW for quinolones?
Tendonitis/tendon rupture
110
What are the adverse reactions from quinolones?
GI Distress Hepatotoxicity Nephrotoxicity Glucose changes Seizures Photosensitivity C diff HA/Dizziness
111
What is the MOA of Bactrim?
folate reductase inhibitor and folate synthesis inhibitor
112
What are the first line indications for Bactrim?
MRSA (outpatient) UTI/cystitis Prevention of P jiroveci (option for Legionella and pneumonia)
113
What is the metabolism and excretion of Bactrim?
Liver metabolism and excreted by kidneys
114
Who should not get Bactrim?
Folate deficient (poor nutrition, alcoholics)
115
What are the adverse reactions to Bactrim?
Megaloblastic anemia N/V/D Photosensitivity Hepatotoxicity
116
What pregnancy category is Bactrim?
C
117
What is the MOA of Macrobid?
Inhibits bacterial enzymes and damages DNA
118
What is the coverage of Macrobid?
E coli in the urine
119
What are contraindications for Macrobid?
Renal impairment Pregnancy
120
What are common adverse effects of Macrobid?
N/V
121
What is the MOA of Flagyl
Disrupts microbial DNA
122
What is the spectrum of activity for Flagyl?
Gram + Gram - Anaerobes Protozoans
123
What are the first line indications for Flagyl?
Trichomonas Bacteria Vaginosis C diff Amebiasis Giardiasis
124
How is Flagyl metabolized?
Metabolized by liver and excreted by kidneys
125
What are the adverse reactions for Flagyl?
GI distress N/V/D Metallic taste Disulfiram-like reaction
126
What is a CI for Flagyl?
Alcohol use
127
What is the BBW for flagyl?
Cancer causing in mice and rats
128
What is Silvadene used for?
Topical burn cream
129
What is sulfacetamide use for?
Solution or ointment for ophthalmic infections
130
What is Daraprim used for?
Antiparasite/antimalarial
131
What is bacitracin used for?
topical ointment against staph/strep
132
What is polymyxin B used for?
Ophthalmologic drops for pseudomonas in the eye
133
What is chloramphenicol used for?
Almost never used but can be used as ophthalmic solution or IV, very broad spectrum
134
What is mupirocin used for?
Impetigo/skin infections Can be used to decolonize MRSA with chlorhexidine

ID/ENT (11 decks)

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