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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
Q

What are common indications for Ancef (cefazolin)?

A

Surgical prophylaxis
Serious MSSA infections (endocarditis, PNA, UTI)
(cause IM/IV only)

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26
Q

What are common indications for cefadroxil (Duricef, Ultracef)

A

Pharyngitis/tonsillitis
Advantage is that it is taken BID

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27
Q

What are the 2nd generation cephalosporins?

A

Cefuroxime
Cefoxitin
Cefotetan
Cefaclor
Cefprozil

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28
Q

What are the indications for cefoxitin/cefotetan?

A

surgical prophylaxis for dirty procedures

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29
Q

What are the indications for cefuroxime/cefaclor/cefprozil?

A

2nd line for pharyngitis, sinusitis, OM, upper and lower respiratory tract infections

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30
Q

What are the 3rd generation cephalosporins?

A

Ceftriaxone (Rocephin)
Cefdinir (Omnicef)
Cefixime (Suprax)

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31
Q

What are the indications for ceftriaxone (Rocephin)?

A

1st line for Neisseria gonorrhoeae
Good for pneumococcals
Open abdominal prophylaxis
Meningitis
PID

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32
Q

What are the indications for cefdinir (Omnicef) and Cefixime (Suprax)?

A

2nd line for upper and lower respiratory infections
Skin and soft tissue infections

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33
Q

What is the 4th generation cephalosporin?

A

Cefepime (Macipime)

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34
Q

What is the spectrum of cefepime?

A

Gram +, gram -, and pseudomonas

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35
Q

When do you use cefepime?

A

Severe infections
Meningitis (bc penetrates CSF)
SAVE THIS DRUG

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36
Q

What is the 5th generation cephalosporin?

A

Cetaroline

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37
Q

What is the spectrum of coverage for ceftaroline?

A

Gram +
MRSA
VRE

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38
Q

Which generations of cephalosporins penetrate the CNS?

A

3 and 4 do well
5 does a little

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39
Q

What is the monobactam?

A

Aztreonam (Azactam)

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40
Q

What generation cephalosporin are monobactams closest to?

A

3rd/4th generation

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41
Q

What is the susceptibility of aztreonam?

A

Gram -
Pseudomonas
No gram + or anaerobes

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42
Q

When do you use aztreonam?

A

Severe UTIs (E coli)
Bacteremia/Sepsis
Inhalation (for CF respiratory infections)

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43
Q

What are the carbapenems?

A

Imipenem/cilastatin
Meropenem
Ertapenem
Doripenem

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44
Q

What is the susceptibility of carbapenems?

A

Very broad spectrum
Gram +
Gram -
Anaerobes
Pseudomonas
NO MRSA

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45
Q

When to use a carbapenem?

A

Severe infections only
UTI
Meningitis
Peritonitis/intra abd infections
Resistant wounds (chronic diabetic)
Osteomylitis

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46
Q

What are the common side effects of beta lactams?

A

GI (N/V/D)
Vaginal candidiasis

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47
Q

What are adverse events for beta lactams?

A

Hypersensitivity
C dif
Nephritis
Anemia, thrombocytopenia
CNS toxicity

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48
Q

How many people claim to be allergic to PCNs? How many are actually allergic?

A

10%, <1%

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49
Q

How are beta lactams metabolized? Excreted?

A

hepatic metabolism and renal secretion

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50
Q

What monitoring should you do for beta lactams?

A

CBC with prolonged treatment for neutopenia
Kidney function for prolonged treatment

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51
Q

What pregnancy category are beta lactams?

A

B

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52
Q

What are the drug interactions of beta-lactams?

A

Decrease the effectiveness of oral contraceptives

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53
Q

What drug is a glycopeptide?

A

Vancomycin

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54
Q

What is the MOA of vancomycin?

A

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
Q

How can bacteria be resistant to vancomycin?

A

Bacteria alter the binding site to D-ala D-lac so vanc cannot bind. Seen in VRE.

56
Q

What is the spectrum of vancomycin?

A

Gram + cocci and bacilli
Specifically MRSA and C diff

57
Q

What are the indications for vancomycin?

A

MRSA
Severe C dif

58
Q

How is vanc metabolized and excreted?

A

Not metabolized but is renally excreted, must adjust for renal impairment

59
Q

What is the pregnancy category for vancomycin?

A

B for oral and C for IV
Must do benefit risk assessment

60
Q

What does vancomycin dosing rely on?

A

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
Q

When is steady state of vanc reached?

A

4th dose in normal renal concentration

62
Q

What are the adverse effects of vancomycin?

A

Red man syndrome
Nephrotoxicity
Ototoxicity

63
Q

What drugs are aminoglycosides?

A

Gentamicin
Tobramycin
Amikacin
Streptomycin

64
Q

What is the MOA of aminoglycosides?

A

Bind to the 30s subunit which inhibits bacterial protein synthesis which is bacteriostatic. They suppress bacterial growth for a little after stopping ABx.

65
Q

How do aminoglycosides gain resistance?

A

Chromosomal mutation of 30s
Enzymatic destruction of ABx
Lack of permeability through cell wall
Efflux pumps

66
Q

What is the spectrum of aminoglycosides?

A

Gram -
Mycobacterium tuberculosis (Atypical)
NO Gram +

67
Q

What are the BBW for aminoglycosides?

A

Ototoxicity
Nephrotoxicity
Neuromuscular paralysis

68
Q

Which aminoglycoside is topical?

69
Q

Which aminoglycoside is a ophthalmic drop?

A

Tobramycin

70
Q

What are aminoglycosides most commonly paired with?

A

A PCN such as ampicillin + Gentamycin to make a broad spectrum therapy

71
Q

What pregnancy category are aminoglycosides?

A

D for do not use

72
Q

What is dosing of aminoglycosides based off of?

A

Weight and renal function, monitor peak and trough levels

73
Q

What monitoring needs to be done with aminoglycosides?

A

BUN/Cr
Audiometry for long term, high doses

74
Q

What drugs are tetracyclines?

A

Tetracycline
Doxycycline
Minocycline

75
Q

What is the MOA of tetracycline?

A

Bind 30S ribosomal subunit and block tRNA binding (bateriostatic)

76
Q

How to bacteria resist tetracyclines?

A

Efflux pumps
Enzyme deactivation

77
Q

What is the spectrum of activity of tetracyclines?

A

Gram +
Gram -
MRSA
Atypicals (Mycoplasma, Rickettsiae, Chlamydiae, Spirochetes)

78
Q

What are the first line indications for tetracyclines?

A

Lyme Disease
Rocky Mountain Spotted Fever
Cholera
Acne
Chlamydia
CAP

79
Q

What are the contraindications for tetracyclines?

A

Children <8-9 years old, <13 is not preferred
Pregnancy and nursing

80
Q

What is the metabolism of tetracyclines?

A

Metabolized in liver and excreted via urine and bile

81
Q

What should tetracycline not be taken with?

A

TUMS/antacids

82
Q

What are the adverse effects of tetracyclines?

A

GI distress
Hepatotoxicity
Photosensitivity
Vertigo
Candida infections
C diff

83
Q

What drugs are macrolides?

A

Azithromycin (Zithromax)
Erythromycin
Clarithromycin

84
Q

What is the MOA of macrolides?

A

Inhibits protein synthesis and translocation needed to replicate by binding to the 50S subunit

85
Q

How do macrolides gain resistance?

A

50s subunit target modification
Efflux pumps
Degradation enzymes

86
Q

What is the spectrum of activity of macrolides?

A

Gram +
Gram -
Atypicals

87
Q

What are first line indications for macrolides?

A

CAP
Chlamydia
Legionella
Diphtheria
COPD
(2nd line OM, pharyngitis)

88
Q

Can you use z-pack for sinusitis?

A

No. Use augmentin

89
Q

Which has broader coverage of the macrolides?

A

azithromycin (also the only IV one)

90
Q

What is the metabolism and excretion of macrolides?

A

Metabolized by liver, eliminated in bile, caution with liver impairment

91
Q

What are the adverse effects of macrolides?

A

GI, N/D and C diff
Hepatotoxicity
Prolonged QT interval
Ototoxicity

92
Q

What pregnancy category are macrolides?

93
Q

What is the MOA of clindamycin?

A

Same as macrolides, Inhibits protein synthesis and translocation needed to replicate by binding to the 50S subunit

94
Q

What is the spectrum of activity for clindamycin?

A

Gram +
MRSA (some strains)
Anaerobes

95
Q

What are indications for clindamycin?

A

Oral abscesses
Endocarditis prophylaxis
Bacterial Vaginosis
MRSA skin/soft tissue infections

96
Q

What are the side effects of clindamycin?

A

Diarrhea, nausea
skin rashes

97
Q

What is the BBW for clindamycin?

98
Q

What pregnancy category is clindamycin?

99
Q

What drugs are quinolones?

A

Ciprofloxacin
Levofloxacin
Moxifloxacin

100
Q

What is the MOA of quinolones?

A

Inhibition of DNA gyrase and topoisomerase causes rapid bactericidal activity

101
Q

How do bacteria resist quinolones?

A

Mutation in chromosomal genes of gyrase and topoisomerase
Efflux pump
Decreased cell wall permeability

102
Q

What is the spectrum of activity of quinolones?

A

Gram - > gram +
Moxifloxacin also has anaerobic

103
Q

When is cipro used vs Levo and moxi?

A

Cipro is belly button down
Levo/Moxi are belly button up

104
Q

What are the first line indications for quinolones?

A

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
Q

What is the metabolism of quinolones?

A

Liver metabolism and urine/feces excretion

106
Q

What are the contraindications for quinolones?

A

Prolonged QT/arrhythmias
Myasthenia Gravis

107
Q

Can you use quinolones in kids?

A

Yes if necessary but not first line

108
Q

What is the pregnancy rating of quinolones?

109
Q

What is the BBW for quinolones?

A

Tendonitis/tendon rupture

110
Q

What are the adverse reactions from quinolones?

A

GI Distress
Hepatotoxicity
Nephrotoxicity
Glucose changes
Seizures
Photosensitivity
C diff
HA/Dizziness

111
Q

What is the MOA of Bactrim?

A

folate reductase inhibitor and folate synthesis inhibitor

112
Q

What are the first line indications for Bactrim?

A

MRSA (outpatient)
UTI/cystitis
Prevention of P jiroveci
(option for Legionella and pneumonia)

113
Q

What is the metabolism and excretion of Bactrim?

A

Liver metabolism and excreted by kidneys

114
Q

Who should not get Bactrim?

A

Folate deficient
(poor nutrition, alcoholics)

115
Q

What are the adverse reactions to Bactrim?

A

Megaloblastic anemia
N/V/D
Photosensitivity
Hepatotoxicity

116
Q

What pregnancy category is Bactrim?

117
Q

What is the MOA of Macrobid?

A

Inhibits bacterial enzymes and damages DNA

118
Q

What is the coverage of Macrobid?

A

E coli in the urine

119
Q

What are contraindications for Macrobid?

A

Renal impairment
Pregnancy

120
Q

What are common adverse effects of Macrobid?

121
Q

What is the MOA of Flagyl

A

Disrupts microbial DNA

122
Q

What is the spectrum of activity for Flagyl?

A

Gram +
Gram -
Anaerobes
Protozoans

123
Q

What are the first line indications for Flagyl?

A

Trichomonas
Bacteria Vaginosis
C diff
Amebiasis
Giardiasis

124
Q

How is Flagyl metabolized?

A

Metabolized by liver and excreted by kidneys

125
Q

What are the adverse reactions for Flagyl?

A

GI distress N/V/D
Metallic taste
Disulfiram-like reaction

126
Q

What is a CI for Flagyl?

A

Alcohol use

127
Q

What is the BBW for flagyl?

A

Cancer causing in mice and rats

128
Q

What is Silvadene used for?

A

Topical burn cream

129
Q

What is sulfacetamide use for?

A

Solution or ointment for ophthalmic infections

130
Q

What is Daraprim used for?

A

Antiparasite/antimalarial

131
Q

What is bacitracin used for?

A

topical ointment against staph/strep

132
Q

What is polymyxin B used for?

A

Ophthalmologic drops for pseudomonas in the eye

133
Q

What is chloramphenicol used for?

A

Almost never used but can be used as ophthalmic solution or IV, very broad spectrum

134
Q

What is mupirocin used for?

A

Impetigo/skin infections
Can be used to decolonize MRSA with chlorhexidine

ID/ENT (11 decks)

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