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Year 1: Patho/Pharm > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Mechanism of Action
Penicillins

A

beta-lactam antibiotic
binds to penicillin binding proteins:

  1. Inhibit transpeptidase cell wall cross link
  2. Activation autolysin

weakens the cell wall
results in bacterial cell lysis

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2
Q

SE of Penicillins

A
  1. CNS toxicity (hallucinations, delusions, seizures)
    Renal dose adjustment required
  2. Anaphylaxis 7/100 people
  3. GI upset
  4. Blood dyscaria
  5. phlebitis if IV
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3
Q

Penicillins and pregnancy

A

safest antibiotic
PBPs only exist in bacteria

Safe in pregnancy, infancy, childhood, old age

Amoxicillin safe in breast feeding

First line treatment for pregnancy UTIs

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4
Q

Penicillin G and V Coverage

A

Gram positive bacteria

Anaerobic Spirochettes (Treponem pallidum - syphillus)

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5
Q

Penicillin is used to treat…

A

Meningitis - streptococcus pneumoniae

Group A strep infections (GAS)

Syphillus

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6
Q

MOA and SE of Cephalosporins

A

MOA:
beta-lactam antibiotic
weaken cell wall
bind PBP
*same as penicillins

  1. CNS toxicity (renal dose adjustment required)
  2. Disulfram reaction (acetaldehyde build up if you drink)
  3. C. diff infections (during and post)
  4. Bleeding (inhibits Vitamin K coagulation factor synthesis)
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7
Q

Which Cephalosporins cross the BBB

A

Third generation
- Cefixime, Cefotaxime, Ceftazidime, Ceftriaxone

Fourth Generation
- Cefepime

Fifth Generation (USA only)
- Ceftaroline

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8
Q

Which Cephalosporins cover pseudomonas infections?

A

Third generation (ceftazidime)

Fourth generation
(cefepime)

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9
Q

Which cephalosporins cover MRSA infections

A

Fifth generation
Ceftaroline

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10
Q

First generation Cephalosporins

A

Cephalexin
Cefazolin
Cefadroxil

*cross reactivity with penicillin 1%
contraindicated with penicillin anaphylaxis

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11
Q

Second generation cephalosporins

A

Cefaclor
cefuroxime
cefoxitin
cefprozil
cefotetan

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12
Q

Third generation cephalosporins

A

Cefotaxime
Ceftriaxone
ceftazidime
Cefixime

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13
Q

Fourth and fifth generation cephalosporins

A

Cefepime
ceftaroline

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14
Q

Penicillins

A

Penicillin G
Penicillin V
Cloxicillin
Amoxicillin/Clavulanate
Ampicillin/Sulbactam
Pipperacillin/tazobactam

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15
Q

Carbapenems MOA and route

A

beta-lactam antibiotic
bind to PBPs 1. transpeptidase inhibitor 2. autolysin disinhibitor

Imipenem
Meropenem
Ertapenem

*IV Only

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16
Q

Prescribing considerations and contraindications of carbapenems

A

IV only

gram positive, negative, pseudomonas infections - broad spectrum, empric

Do not give alone to treat pseudomonas to avoid resistance (prescribe with pipperacillin/tazobactam and/or aminoglycosides)

Contraindicated with VPA (seizures)

Renal dose adjustment

1% cross reactivity with penicillins

Super infections

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17
Q

Carbapenem SE

A

N/V/D
superinfections
hypersensitivity
cross reactivity with penicillins 1%
seizures with VPA

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18
Q

Mechanism of action carbapenems

A
  1. inhibition transpeptidase
  2. activation autolysin

Disrupt cell wall synthesis resulting in bacterial lysis

Only active against actively growing and dividing bacteria

Resistant against beta-lactamases - do not need to prescribe sulbactam, clavulanate, or tazobactam

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19
Q

Mechanism of action cephalosporins

A
  1. Inhibition transpeptidase
  2. Activation autolysin

Disrupt cell wall synthesis resulting in lysis of bacteria
*beta-lactam antibiotic
same as penicillins and carbapenems

3rd and 4th resistant against beta lactamases, BBB penetration, and pseudomonas coverage
5th generation MRSA coverage

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20
Q

Cephalosporins SE, and pregnancy

A

SE:
N/V/D, c.diff
disulfram reaction
neuerotoxicity
cross reaction with penicillins 1% first generaitons
bleeding risk

safe in pregnancy
safe in breastfeeding
3rd generations used to treat infants
dose reduction in kidney disease

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21
Q

Vancomycin

Mechanism of Action

A

Disrupts cell wall synthesis by binding to cell wall precursors - peptidoglycans

Results in cell lysis

Not absorbed systemically through PO administration - too big

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22
Q

Vancomycin

SE

A

Ototoxic - high pitch, low pitch, blance

Nephrotoxic - casts, proteinuria

Blood trough level (low trough)
TDM required
Monitor BUN, creatinine clearance

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23
Q

Pathophysiology of

C. Difficile

A

Antibiotics kill microbiome
Overgrowth of bad bacteria such as C. Diff

Toxin A and B produced and damage colon
Inflammation, pus, watery diarrhea

Gram positive, spore forming bacteria

First line treatment: Metronidazole IV and Vancomycin PO

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24
Q

Vancomycin and Pregnancy

A

PO vancomycin does not get absorbed systemically (too big, hydrophilic), safe in pregnancy and breast feeding

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25
Vancomycin Coverage
Gram positive bacteria and MRSA MRSA (gram positive cocci in clusters) - methicillin resistance, PBP different shape C. difficile (gram positive bacilli)
26
Fosfomycin Coverage
Gram positive, Gram negative, Pseudomonas *Cannot be used to treat pyelonephritis/renal infections (systemic) - too big to be absorbed
27
Fosfomycin mechanism of action
Prevents production of the building blocks of the cell wall peptidoglycan layer Disrupts cell wall synthesis
28
Penicillin and Cephalosporin Drug interactions
Oral contraceptives Probenicid (increases level) Synergistic with aminoglycosides
29
Antibiotics that inhibit 50S Ribosome Subunit
Macrolides (Azithromycin, Erythromycin, Clarithromycin) Licosamides (Clindamycin, linomycin) Linezolid
30
Macrolide SE
1. Prolonged QT interval 2. Ototoxic 3. Diarrhea (Motilin receptors) and metallic taste in mouth 4. Elevated LFTs (biliary clearance) 5. Renal dose adjustment needed
31
Macrolide Drug interactions
Inhibition CYP450 Synergistic with beta-lactam antibiotics
32
Macrolide coverage
Atypical infections (GERD, CAP, STIs) Gram positive, gram negative (no pseudomonas coverage)
33
Erythromycin Drug Interactions
CYP3A4 metabolism Cardiac death increases 6x when prescribed with CYP3A4 inhibitors - CCB - Azoles - HIV protease inhibitors - Anti-depressants Inhibits CYP450 Enzyme, increasing level of - warfarin - theophylline - carbamazepine
34
Macrolide mechanism of action
Inhibition 50S subunit on the ribosome Bacteriostatic and bacteriocidal at higher concentrations
35
Licosamide antibiotics and mechanism of action
Clindamycin Linomycin Bacteriostatic and bacteriocidal Inhibit 50S ribosomal subunit
36
Macrolides and Pregnancy
Safe in pregnancy however crosses the placenta > 1 month of age Do not breast feed
37
Clindamycin SE
1. QT Interval prolonged 2. LFT elevation 3. renal dose adjustment (similar to macrolide) 4. C. diff infection (4 -6 weeks post, fatal) 5. Rash/hypersensitivity/SJS*
38
Clindamycin Coverage
MRSA Gram positive Anaerobes Examples: Gardenella Vaginalis Clostridium MRSA Acne Intra-abdominal infections and ulcers Gangrene
39
Clindamycin and Pregnancy
Safe in pregnancy Avoid breast feeding - secreted in breast milk
40
Drugs that CANNOT cross the BBB
- 1st and 2nd generation cephalosporins - Clindamycin - Macrolides - Fluroquinolones
41
Mechanism of Action Linezolid
Binds to the 23S portion of the 50S ribosomal subunit and stop s protein synthesis bacteriostatic
42
SE of linezolid
Myelosupression (monitor CBC weekly) demyelination CNS Hypertensive crisis Serotonin Syndrome
43
Linezolid coverage
gram positive organisms MRSA V
44
Linezolid drug interactions
Do not prescribe with - MAOI - SSRI - Sympatheticomimetics (methylphenidate, etc.)
45
Aminoglycosides
Gentamycin Tobramycin Streptomycin Neomycin Amikacin *end in mycin
46
Aminoglycoside mechanism of action
bind to the 30S ribosomal subunit and 1. prevent activation 2. early termination of protein synthesis 3. mis-reading of proteins, mutation Bacteriostatic Bacteriocidal - mutated proteins inserted into membrane and lysis results
47
Aminioglycoside SE and contraindications
Neurotoxic Nephrotoxic Ototoxic (hearing, and balance) Teratogenic (do not use if pregnant) Do not breast feed *lacking data
48
Aminoglycoside coverage
Pseudomonas Gram negative bacteria *no coverage for gram positive *no coverage for anaerobes * does not cross the BBB or GI (too positively charged) IV form or IM form only
49
Aminoglycoside drug interactions
Caution with - Nephrotoxic drugs - ototoxic drugs - perforated ear drum D/C Synergistic with - beta-lactam antibiotics or vancomycin - do not mix in the same IV bag *precipitates out
50
Aminoglycoside monitoring
Peak and trough levels *high trough is associated with high SE, want it as close to zero as possible
51
Tetracyclines
Tetracycline doxycycline minocycline
52
Tetracycline mechanism of action
Inhibits 30S ribosomal subunit prevents synthesis of the protein / misread / early termination
53
Tetracycline contraindications
Children < 8 years Pregnancy Post-Partum women Breastfeeding
54
Tetracycline SE
Deposition in bones (growth suppression) Deposition in enamel (yellow/grey teeth) and hypoenamel Hepatotoxic / Renal toxicity (higher in pregnant and post partum women) GI upset sunburn / photosensitivity C. difficile infections
55
Tetracycline drug interactions
Increase levels of digoxin and warfarin Cations decrease absorption, do not take with food (1 hour before, 2 hours after)
56
Tetracycline coverage
MRSA, Gram positive, some gram negative *Used to treat peridontal, acne, and atypical infections (spotted fever, lyme disease, anthrax etc.)
57
Nitrofurantoin drugs
Nitrofurantoin Macrobid
58
Nitrofurantoin Mechanism of Action
Binds to 30S ribosomal subunit and inhibits protein synthesis Prodrug is activated by bacterial enzyme
59
Nitrofurantoin Coverage
Gram positive, gram negative *Pseudomonas is resistant
60
Nitrofurantoin SE
Lungs - inflammation lungs (dyspnea, infiltration) D/C - Chronic lung fibrosis Blood - Agranulocytosis, thrombocytopenia, hemolytic anemia (newborn, G6PD deficiency) NEUROTOXICITY - demyelination of sensory and motor neurons - chronic use Heptatotoxicity Birth defects - Do not give in 38th week of pregnancy - Do not breast feed
61
Nitrofurantoin contraindications
Pregnancy 38 weeks Breastfeeding Children < 1 month G6PD Deficiency *hemolytic anemia
62
Nitrofurantoin monitoring
CrCl > 50mL/min in order to reach the bladder If < 50mL/min do not prescribe, it will not reach effective concentration CBC G6PD status Lung function
63
Fosfomycin dosing
Concentration dependent killing one dosage, high concentration, with lots of water
64
Fosfomycin monitoring
Requires CrCl > 50mL/min *similar to Nitrofurantoin
65
Fluroquinolone antibiotics
Ciprofloxacin Moxifloxacin Levofloxacin
66
Fluroquinolone Mechanism of Action
Inhibits DNA replication and cell division through 2 actions: DNA topoisomerase inhibitor - Cannot separate daughter strands during cell division DNA gyrase inhibitor - Supercoils DNA for replication (condenses DNA)
67
Fluroquinolone SE and Contraindications
Contraindications - Pregnancy - Infants/children - Myasthenia gravis - Caution - greater than 60 years, glucocorticoid use, transplants, renal disease (increased risk of tendon rupture) SE - Prolonged QT interval - Tendon rupture - Sunburn / phototoxicity - CNS toxicity - seizures - C. Diff infections
68
Fluroquinolone Coverage
Gram positive Gram negative Pseudomonas *Neisseria gonorrhea is resistant
69
Fluroquinolone drug interactions
Cations decrease absorption increase warfarin, theophylline and carbamazepine (CYP450 inhibitor)
70
Fluroquinolone monitoring
CrCl high risk for CNS toxicity and tendon rupture if renal disease
71
Metronidazole mechanism of action
Prodrug activated by bacterial enzyme Generates ROS which damage DNA Concentration dependent killing
72
Metronidazole coverage
Anaerobes, protozoa fusobacterium, gardenella vaginalis, trichomatis, C. difficile, etc.
73
Metronidazole SE and education
VRE Carcinogenic in mice GI upset hepatotoxic (metabolism) Disulfram reaction (do not drink)
74
Metronidazole contraindications
- alcohol - caution in liver disease
75
Metronidazole in pregnancy and breast feeding
Can take while pregnant Will result in bitter tasting breast milk
76
Sulfonamide SE
Rash Phototoxicity Hemolytic anemia (< 2 months, G6PD deficiency) agranulocytosis, thrombocytopenia kernicterus (displaces from bilirubin) Renal toxicity - crystalizes
77
Sulfonamide Education
- do not breast feed (kernicterus, hemolytic anemia) - drink 8-10 glasses of water a day
78
Sulfonamide drug interactions
Increases dose of - hypoglycemics - warfarin - AEDs (phenytoin)
79
Sulfonamide Contraindications
- Sulfa allergy - Pregnancy first / third trimester - breast feedin - infants < 2 months old - G6PD deficiency - Caution in elderly - more likely to have TEN, SJS, and neutropenia
80
Trimethoprim mechanism of action
inhibition of folate synthesis unable to replicate DNA/RNA
81
SE of Trimethoprim
Megaloblastic anemia (more common pregnant, alcoholics) hyperkalemia (worsened by ACE inhibitors, ARBs, potassium sparing diuretics) Do not give in first and third trimester (Neural tube risk)
82
Trimethoprim contraindications
- folate deficiency - pregnancy (first trimester - NTD) - lactation
83
TMP/SMX monitoring
- CBC and WBC differential - CrCl (reduce dose by 50% if CrCl < 30) - Potassium - Pregnancy stage
84
TMP/SMX ratio
1:5

Year 1: Patho/Pharm (45 decks)

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