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Antibiotics > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Cell wall active

A

Pen, Ceph, Carbapenims, Vanc, dapto, poly

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2
Q

Beta lactam side effects

A

Seizures (imipenem, cefepime), anaphylaxis, biliary stasis (ceftriaxone), interstitial nephritis, hypersensitivity hepatitis (oxacillin), myelosuppression - leukopenia, hemolytic anemia

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3
Q

ESBL pattern

A

R to pen, aztreonam, cefazolin, ceftazidime, ceftriaxone (avoid pip/tazo)

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4
Q

KPC resistance pattern

A

All tested cephalosporins, carba, aztreonam

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5
Q

Chromosomal induced AMP C resistance

A

KEC: Klebsiella (previously Enterobacter) aerogenes, Enterobacter cloacae, Citrobacter freundii

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6
Q

Van A or Van B Enterococci - what is the species?

A

Enterococci faecium, Vanc MIC > or = to 32

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6
Q

Enterococci with vanc MIC 8-16

A

E. gallinarum, E. casseliflavus/flavescens. Not epidemiologically significant in hlthcare setting

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7
Q

UL97 mutation in CMV confers what resistance

A

ganciclovir, marabvavir

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7
Q

Mycoplasma hominis - what abx to use?

A

Can’t use cell wall active drugs. Use tetracycline, FQ, Clinda. Do NOT use AF, TMP, Erytho or azithromycin

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8
Q

UL54 mutation confers what resistance?

A

ganciclovir, cidofovir, foscarnet

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9
Q

UL56 mutation confers what resistance?

A

Letermovir

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10
Q

cephalosporins 1

A

cidal, time dependent, fewer side effects than pen, most renally excreted, CSF penetration with 3rd gen

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11
Q

cephalosporins 2 key points

A
  • enterococci: none are active
  • only cephamycins active against anaerobes: cefoxitin, cefotetans both have high level of resistance
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12
Q

Ceftaroline

A
  • Gram +, including MRSA, MDR S. Pneumo
  • limited anaerobes - Cutibacterium (formerly Prprionobacterim), Actinomyces spp
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13
Q

Ceftaroline 2

A
  • active against gram neg: E. coli, Kleb spp, H. influ, M. catarrhalis
  • NOT for Pseudomonas or ESBL GNB
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14
Q

Vanc resistance

A
  • Not in Strep
  • Rare in Staph
  • Common in Enterococcus faecium (rare in E. faecalis
  • change in vanc binding site
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15
Q

Vanc toxicity with other drugs

A

AG, NSAIDS, contrast, Cyclosporin, tacrolimus, loop diuretics, ACEI, pip/tazo (pseudo interaction)

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16
Q

Daptomycin

A

cidal, lipopeptide, Gram + activity (including MRSA & VRE), concentration dependent, cell membrane depolorization

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17
Q

Daptomycin indications

A
  • cSSSI, S. aureus bactermia, rt sided endocarditis
  • NOT for pneumonia - inactivated by surfactant
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18
Q

Daptomycin toxicity

A
  • monitor CPK twice weekly - d/c if myopathy or CPK > 5x ULN
  • eosinophilic pneumo
  • falsely prolonged prothrombin time
  • muscle inflammation - renal failure, obesity, statins
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19
Q

Long acting glycopeptides

A
  • Oritavancin and Dalbavancin
  • inhibit cell wall synthesis
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20
Q

Ortivancin & Dalbavancin dosing

A
  • IV only
  • Ortivancin - 1 dose over 3 hours
  • Dalbavancin - 1000 mg x1, then 500 mg q 7 days or 1500 mg x1
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21
Q

Ortivancin & Dalbavancin indications

A
  • skin & soft tissue
  • Dalba - osteo & rt sided endocarditis
  • Orti - FDA warning against use in osteomyelitis
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22
Q

lipo/glycopeptide toxicities

A
  • vanc: nephro, histamine release
  • Dapto: CPK increase, myopathy
  • Telavancin: nephro
  • Ortivancin: LFT increase, increase in PT & activated whole blood clotting time x 5 days, false increase aPTT,
    -Dalba: LFT increase
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23
Q

FQ good for MRSA

A

Delafloxacin but not if invasive disease

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24
Q

ABX active intracellularly

A

FQ, Tetracyclines, Linezolid, TMP/SMZ, Pleuromutilins

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25
Q

FQ resistance

A
  • drug permeability mutations
  • occurs spontaneously on therapy
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26
Q

cipro spectrum

A
  • poor Strep
  • Some MSSA
  • Best FQ for Pseudo & E. Coli (watch antibiogram - may have resistance)
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27
Q

Levo spectrum

A
  • Good Strep
  • Some MSSA
  • Best FQ for Stenotrophomonas
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28
Q

Moxi spectrum

A
  • Good Strep
  • Good MSSA
  • Best FQ for anaerobes - use in intra-abdominal
  • Not effective against Gm neg - DO NOT use for UTI
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29
Q

FQ properties

A

-therapeutic concentration in CSF, but lower than in serum
- levo/cipro - renal excretion
- Moxi >60% hepatic/biliary unchanged

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30
Q

FQ side effects

A
  • QT prolongation - watch for low K+, Mg++, bradycardia, cardiomyopathy
    -aortic aneurysm/aortic dissection
  • dysglycemia - high and low
  • AMS - dizzy, HA, insomnia
  • C diff
  • tendonopathy (older, poor renal fxn, steroids)
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31
Q

Delafloxacin

A

IV and oral BID
- MRSA actrivity
- broad spectrum including pseduomonas but not great
- approved skin and soft tissue

32
Q

Tetracyclines activity

A

-Lyme
-Anaplasmosis
- Ehrlichiosis
- RMSF
- community acquired MRSA
- STIs
- Acne

33
Q

Omadacycline (tetra)

A
  • CABP
  • ABSSSI
  • IV & oral
  • Gm pos including MRSA, VRE
  • GM neg including ESBL, CRE (not all), anareobes
  • side effects: GI, rash
34
Q

Eravacycline (tetra)

A
  • complicated intra-abdom IV only, not complicated UTI
  • IV & oral
  • dose adjust for hepatic failure
  • Gm pos including MRSA, VRE
  • GM neg including ESBL, CRE (not all), anareobes
  • hihg MIC Pseudomonas, Burkholderia
  • side effects: GI, rash
35
Q

Oxazolidinone

A

Linezolid & Tedizolid
- bind 50s ribosome
-gram Pos cocci (MRSA & VRE)
- mycobacteria

36
Q

Linezolid

A
  • resistance S. aureus reported
  • BID
  • FDA approval - skin, soft tissue, Pneumonia, VRE
  • NOT for bloodstream infection - black box warning
37
Q

Tedizolid dosing

A
  • once daily dosing
38
Q

linezolid adverse events

A
  • mitochondrial toxicity
  • cytopenias - monitor CBC
  • peripheral & optic neuropathy
  • rare lactic acidosis, serotonin syndrome with SSRIs
  • increase mortality with IV catheter associated bacterimia
39
Q

TMP/SMX spectrum

A
  • gram Positive
    – staph great
    – Strep - controversial
    – Enterococcus - not effective
  • gram Negative
    – increasing resistance E. Coli
    – relatively effective enterobacterales
    – not effective pseudomonas, acinetobacter
    – often drug of choice for Stenotrophomonas
40
Q

Lefamulin

A
  • pleuromutilin
  • IV & PO
  • static
  • FDA approved CABP
    –5 days po lefamulin
41
Q

Macrolides

A
  • 50s ribosome
  • Spectrum
    – Strep pneumo (increasing resistance- fo not use if local R is >25%)
    – H. influ
    – Moraxella catarrhalis
    – Legionella spp
    – Strep Aa, C, G
42
Q

VRE (E. Faecium) drugs if vanc and amp resistant

A
  • Linezolid (FDA approved)
  • Dapto plus amp or ceftaroline or ceftriaxone
  • Amp if MIC < 32
  • Unasyn if resistance due to beta lactamase
  • NOT Quinupristin/dalfopristin as FDA approval withdrawn
  • Cystitis - nitrofurantoin or fosfamycin
43
Q

Antipseudomonal cephalosporins

A
  • cefepime
  • ceftazidime
  • ceftolozone/tazo
44
Q

Protein synthesis inhibitors

A

tetracyclines, linezolid, AG, Macrolides, clindamycin

45
Q

Concentration dependent (post antibiotic effect)

A

AG, dapto, metronidazole, FQ

46
Q

Time dependent

A

Pen, Ceph, aztreonam, carbapenems

47
Q

time and post antibiotic effect

A

vanc, macrolides, tetra, linezolid, clindamycin

48
Q

CAP and Doripenem

A

Do not use! Failed against CAP.

49
Q

pip/tazo and nephrotoxicity

A

pip competes with creatinine for secretion in the proximal tubules - pseudotoxicity

50
Q

Non fermenters

A

Acinetobacter, Burkholderia, Pseudomonas aeruginosa, Stenotrophomonas maltophilia

51
Q

GN rod resistant to aztreonam

A

think ESBL

52
Q

ESBL preferred txt

A

Meropenem or alternate is ceftolozane/tazo or cefepime (if low MIC)
- others - FQ, plazomicin
- avoid pip/tazo

53
Q

ESBL uncomplicated UTI

A

-fosfomycin
-amox/clav
-nitrofurantoin

54
Q

AMP C enzymes hydrolyze all cephalosporins except

A
  • ceftolozone/tazo
    -ceftaz/avibactem
  • cefideracol
  • emperic txt of KEC meropenen or ceftolozane/tazo
55
Q

2 mechanisms for AMP C

A

1) on plasmid gene - constitutive synthesis (found in E coli and Klebsiella spp)
2) xsome of KEC

56
Q

KEC organisms

A

1) Klebsiella aerogenes (previously Enterobacter)
2) Enterobacter cloacae
3) Citrobacter freundii

AMP C often repressed, activated on exposure to cephalosporin

  • emperic txt of KEC meropenen or ceftolozane/tazo
57
Q

define difficult to treat P. aeruginosa

A

R to pip/tazo, ceftaz, cefepime, aztreonam, meropenem, imipenem, levo, cipro

  • drug to treat - ceftolozane-tazobactam
58
Q

cephalosporin crossreactivity

A
  • ceftazidime
  • cefiderocol
  • aztreonam

have identical side chains

59
Q

cephalosporin that crsytalizes in biliary tree

A

ceftriaxone
pseudo-cholelithiasis

60
Q

cephalosporin with non-convulsive status epilepticus side effect

A

cefepime

61
Q

carbapenem with no Pseudomonas nor non-fermenter activity

A

Ertapenem

62
Q

avoid which carbapenem in meningitis

A

Imipenem-cilastatin

due to seizures

63
Q

relebactam in imipenem - cilastatin - relebactam not protective against which organisms

A

Morganellacea gp
- providencia
- morganella
- proteus

64
Q

Carbapenem not active against

A
  • MRSA
  • Steno maltophilia
  • Acinetobacter (variable)
  • E. faecium
65
Q

FQ that doesn’t get into the urine

A

Moxifloxacin

66
Q

which FQ inhibits cytochrome P450

A

cipro

67
Q

what FQ drug interaction lowers seizure threshold

A

NSAIDs and FQ
-displaces GABA from receptors

68
Q

what drugs lower serum level of Moxifloxacin

A

rifampin and rifapentine
- important for combined txt of mycobacteria

69
Q

what factors increase risk of tendinopathy with FQ

A
  • age over 60
  • oral steroids
70
Q

FQ adverse events

A
  • aortic aneurysm/dissection
  • tendinopathy
  • arthropathy
71
Q

AG have no activity against

A
  • gram pos cocci
  • anaerobes
  • non-fermentors
72
Q

only monotherapy for AG

A
  • tularemia
  • plague - Yesinia pestis
73
Q

Bacteroides txt

A
  • gold standard metronidazole
  • pip/tazo
  • amp/sulb
    -carbapemems
    -moxi
  • erava/omadacycline
74
Q

indications for metronidazole

A
  • Bacteroides
  • bacterial vaginosis
  • amebiasis
  • giardiasis
  • trichomonas vaginitis
  • combo therapy for H pylori
75
Q

Anaerobes resistant to metronidazole

A
  • P. (Cutibacterium acnes
  • Peptostreptococci
    -Eikenella
  • Actinomyces
76
Q

amphotericin B resistant

A
  • Scedosporium apiospermum (previously Pseudallescheria boydii)
  • Aspergillus terreus
  • variable with Candida lusitaniae, C. aureus
77
Q

fluconazole resistant

A
  • all moulds
  • C. krusei
  • C. aureis
  • C. haemulonii
  • some C. glabrata
78
Q

Voriconazole resistant

A
  • mucormycosis
  • uncommon cryptic Aspergillus spp (lentulus, ustus, calidoustus)
79
Q

posaconazole resistant

A
  • mucormycosis (more activity than vori)
  • uncommon cryptic Aspergillus spp (lentulus, ustus, calidoustus)
80
Q

Echinocandin resistant

A
  • cryptococcus
    -trichosporon
  • histoplasma
  • blastomyces
  • coccidioides
  • molds other than aspergillus

Antibiotics (1 decks)

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