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Antibiotics Flashcards

Exam 3

1
Q

What drug classes are antibiotics?

A

Penicillin
Cephalosporin
Macrolide
Tetracycline
Fluoroquinolone
Sulfa
Aminoglycosides
Other (Nitrofurantoin, Metronidazole, Vancomycin, Linezolid

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2
Q

What drug classes are antifungal?

A

Azoles
Non-azoles

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3
Q

What drug classes are antivirals?

A

Anti-herpes virus
Anti-influenza
COVID antiviral
HIV therapy

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4
Q

What drugs are in the Penicillin class?

A

Amoxicillin
Amoxicillin/clavulanate
Penicillin G
Piperacillin/tazobactam

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5
Q

What drugs are in the Cephalosporin class?

A

Cephalexin
Ceftriaxone
Cefazolin
Cefdinir

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6
Q

What drugs are Macrolides?

A

Azithromyacin

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7
Q

What drugs are tretracyclines?

A

Doxycycline

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8
Q

What drugs are Fluoroquinalones?

A

Levofloxacin
Ciprofloxacin

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9
Q

What drugs are Sulfa?

A

Trimethoprim/sulfamethoxazole

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10
Q

What drugs are aminoglycosides?

A

Gentamicin

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11
Q

What antibiotic drugs are “other”?

A

Nitrofurantoin
Metronidazole
Vancomycin
Linezolid

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12
Q

What drugs are Azoles?

A

Ketoconazole
Fluconazole

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13
Q

What drugs are non-Azoles?

A

Terbinafine
Amphotericin B
Nystatin

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14
Q

What drugs are anti-herpes virus?

A

Acyclovir
Ganciclovir

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15
Q

What drugs are Anti-influenza?

A

Oseltamivir

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16
Q

What drug is a COVID antiviral?

A

Paxlovid

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17
Q

What drugs are for HIV therapy?

A

Reverse Transcriptase Inhibitors (Emtricitabine, Efavirenz)

Protease Inhibitor (Ritonavir)

Integrase Inhibitor (Bictegravir)

Fusion Inhibitor (Enfuvitride)

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18
Q

What drugs are Reverse Transcriptase Inhibitors?

A

Emtricitabine
Efavirenz

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19
Q

What drug is Protease Inhibitor?

A

Ritonavir

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20
Q

What drug is Integrase Inhibitor?

A

Bictegravir

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21
Q

What drug is Fusion Inhibitor?

A

Enfuvitride

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22
Q

What are the rash/skin adverse reactions common with Penicillins?

A

Steven-Johnsons Syndrome (SJS)
<10% BSA

Toxic Epidermal Necrolysis (TEN)
>30% BSA

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23
Q

Penicillins: MOA?

A

Inhibits bacterial cell wall synthesis -> weakened cell wall -> cell wall lysis

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24
Q

Penicillin- Indication?

A

Gram-positive bacteria (with thicker cell wall)
Examples:
Staphylococcus
Streptococcus
Pneumonia
Cellulitis
Cystitis
Otitis media (Amoxicillin first line if acute)

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25
Q

Penicillin- side effects?

A

Increased seizure risk- w/ renal accumulation (renal failure- dose adjust)
GI upset
Rash (SJS/TEN)

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26
Q

Penicillin- monitoring?

A

Renal function
Symptoms of anaphylaxis w/ 1st dose

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27
Q

Penicillin G

A

Antibiotic- Natural Penicillin
IV or IM
Narrow coverage

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28
Q

Amoxicillin

A

Antibiotic- aminopenicillin
Medium Coverage
PO
First line for acute otitis media
Endocarditis prophylaxis

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29
Q

Amoxicillin/clavulanate

A

Antibiotic- Penicillin/penicillinase inhibitor combination
Broader coverage
PO
First line for acute otitis media
Sinus infections

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30
Q

Piperacillin/tazobactam

A

Antibiotic- Penicillin/penicillinase inhibitor combo
Broadest Coverage
IV
Pseudomonas (only penicillin that is)- ex. hospital acquired pneumonia

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31
Q

Cephalosporins- MOA?

A

Inhibits cell wall synthesis -> weakened cell wall -> cell death

Excreted by kidneys- except ceftriaxone

(1st gen.: Cephalexin, cefazolin)
(3rd gen.: Ceftriaxone, cefdinir)

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32
Q

Cephalosporins- Indications?

A

Bacterial Infections
Ex:
Cellulitis
Impetigo
Pneumonia

(1st gen.: Cephalexin, cefazolin)
(3rd gen.: Ceftriaxone, cefdinir)

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33
Q

What is a gram positive bacteria?

A

One that needs oxygen

Causes soft tissue infections (cellulitis, impetigo, etc.)

Ex: Streptococcus, MSSA

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34
Q

What is a gram negative bacteria?

A

One that doesn’t need oxygen (thicker cell wall)

Causes UTI, gastroenteritis, pneumonia, etc.

Ex: Non-PsA, Pseudomonas, Acinetobacter, E. coli

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35
Q

Cephalexin / Cefazolin- what generation and HENPECKS status?

A

1st gen: PEK

Proteus, E. coli, Klebsiella
(Strep, MSSA, some non-PsA- gram neg.)

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36
Q

What cephalosporins offer the most gram positive coverage?

A

Cephalexin
Cefazolin

(1st gen)

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37
Q

What cephalosporins offer coverage for gram positive and only PEK?
(Proteus, E. coli, Klebsiella)

A

Cephalexin
Cefazolin
(1st gen.)

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38
Q

2nd Gen cephalosporin- HENPECKS status?

A

Gram positive and HNPEK
Haemophilus
Neisseria
Proteus
Klebsiella

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39
Q

1st gen Cephalosporin- HENPECKS status?

A

Gram positive and PEK

Proteus, E. coli, Klebsiella

(Cephalexin & Cefazolin)

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40
Q

3rd gen Cephalosporin- HENPECKS status?

A

Gram positive and HENPECKS

Haemophilus, E.coli, Neisseria, Proteus, Enterobacter, Citrobacter, Klebsiella, Serratia

(Ceftriaxone & Cefdinir)

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41
Q

What does HENPECKS stand for?

A

Haemophilus, E.coli, Neisseria, Proteus, Enterobacter, Citrobacter, Klebsiella, Serratia

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42
Q

Cephalosporins- side effects?

A

Type 1 penicillin allergy -> anaphylaxis

Risk of seizures if accumulated ex. w/ renal failure

GI upset, diarrhea, allergic reactions, rash (SJS/TEN)

(1st gen.: Cephalexin, cefazolin)
(3rd gen.: Ceftriaxone, cefdinir)

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43
Q

Cephalosporins- notes/monitoring?

A

Renal function, anaphylaxis w/ 1st dose, CBC, LFTs

(1st gen.: Cephalexin, cefazolin)
(3rd gen.: Ceftriaxone, cefdinir)

44
Q

What drug is a glycopeptide?

A

Vancomycin

45
Q

Vancomycin- indications?

A

Gram + bacterial infections only, including anaerobes
MRSA
Streptococci
Enterococci
C. difficile (PO only)

Ex: sepsis, pneumonia, colitis

46
Q

Vancomycin- MOA?

A

Inhibits cell wall synthesis -> Weakens cell wall -> lysis

47
Q

Vancomycin- side effects?

A

Nephrotoxicity
Ototoxicity
Vancomycin infusion reaction (too fast): rash, hypotension, flushing, chills -(tx- slow down, add Benadryl to manage rx)

48
Q

Vancomycin- formulations?

A

IV, PO, PR

49
Q

What drug is a macrolide?

A

Azithromycin

50
Q

Azithromycin- indications?

A

Atypical bacterial infections-
Legionella
Chlamydia
Mycoplasma

Ex: bronchitis, pneumonia, GU infections

51
Q

Azithromycin- MOA?

A

Inhibits bacterial protein synthesis -> inhibits bacterial growth -> bacterial death

52
Q

Azithromycin- side effects?

A

QT prolongation (caution & monitoring w/ methadone)

Contraindicated w/ lovastatin or simvastatin
Caution w/ Warfarin (increased INR)

53
Q

What drug is a tetracycline?

A

Doxycycline

54
Q

Doxycycline- indications?

A

Broad-spectrum, alt. to penicillin in syphilis

Ex: Lyme disease, tick-borne illnesses, CAP, COPD exac., sinusitis, VRE (vancomycin resistant) UTI, STI

55
Q

Doxycycline- side effects?

A

Photosensitivity
Skin reactions
GI inflammation/ulceration

Contraindicated in:
pregnancy
breastfeeding
children <8yeas can suppress bone growth, skeletal development, teeth discolorationD

56
Q

Doxycycline- notes?

A

Sit upright >30min to avoid esophageal irritation

Separate from antacids/polyvalent cations- multivitamins can inhibit absorption

57
Q

What drug is an oxazolidinone?

58
Q

Linezolid- indications?

A

Anaerobes and Gram + bacteria, alt. to penicillin
Vancomycin-resistant enterococci

(similar to vancomycin, plus VRE)

59
Q

Linezolid- MOA?

A

Inhibits protein synthesis

Binds to unique site, different than other antibiotics w/ similar MOA -> effective against bacteria resistant to other meds, ex: vancomycin & methicillin

60
Q

Linezolid- side effects?

A

Serotonergic drug -> risk of serotonin syndrome (increased risk with SSRI use)

Contraindicated: tyramine foods- aged cheese, soy beans, cure/smoked meats, dried fruits

61
Q

Linezolid- formulations?

62
Q

What drug is a folic acid inhibitor?

A

Trimethoprim (TMP) /Sulfamethoxazole (SMX)

63
Q

Sulfamethoxazole (SMX) / Trimethoprim (TMP) - indications?

A

Gram - bacteria , Broader spectrum, opportunistic pathogens

Ex: UTIs
purulent SSTIs (oral MRSA covered)
SBP (spontaneous bacterial peritonitis) prophylaxis
PJP pneumonia (fungal)

64
Q

Sulfamethoxazole (SMX) / Trimethoprim (TMP) - MOA?

A

Inhibits synthesis of proteins and nucleic acids -> kills bacteria

65
Q

Sulfamethoxazole (SMX) / Trimethoprim (TMP) - side effects?

A

Skin reactions (SJS/TEN)
Thrombocytopenic purpura (TTP)
G6PD deficiency

Photosensitivity
Increased potassium
Hemolytic anemiua
Crystalluria (take w/ water)
N/V/D
Renal failure

Increased INR w/ warfarin

Contraindicated if sulfa allergy (bc sulfa drug)

66
Q

Sulfamethoxazole (SMX) / Trimethoprim (TMP) - notes/monitoring?

A

Renal function
Electrolytes
CBC
Folate

67
Q

What drugs are quinolones?

A

Ciprofloxacin
Levofloxacin

68
Q

Ciprofloxacin & Levofloxacin - Indications?

A

Broad-spectrum, Gram +/-, atypical

Ex: UTI, GI infections, Resp. infections,

69
Q

Ciprofloxacin & Levofloxacin - side effects?

A

QT prolongation
Hypo/hyperglycemia
Photosensitivity
Separate from antacids/polyvalent cations (multivitamins inhibit absorption)

Contraindicated for pregnant/breastfeeding

BBW:
tendon inflammation/rupture
Increased muscle weakness in pts w/ myasthenia gravis
CNS effects: seizures, tremor, confusion, psychiatric disturbances
Peripheral neuropathy- maybe irreversible

70
Q

Ciprofloxacin & Levofloxacin - BBW?

A

Tendon inflammation/rupture
Increased muscle weakness in pts w/ myasthenia gravis
CNS effects: seizures, tremor, confusion, psychiatric disturbances
Peripheral neuropathy- maybe irreversible

71
Q

What drug is an aminoglycoside?

A

Gentamicin

72
Q

Gentamicin- Indications?

A

Gram -: Pseudomonas aeruginosa, Proteus, E. coli

Ex: pyelonephritis, GBS

Acute and serious infections

73
Q

Gentamicin- MOA?

A

Inhibits bacterial protein synthesis

74
Q

Gentamicin- side effects?

A

GI upset
Black tarry stools
Blood in urine
Back pain

Renal damage

75
Q

What drugs are anaerobic DNA inhibitors?

A

Metronidazole
Nitrofurantoin

76
Q

Metronidazole- Indications?

A

Anaerobes
Protozoa

Ex: bacterial vaginosis
Trichomoniasis
Intra-abdominal infections (combo antibiotics)

77
Q

Nitrofurantoin- indications?

A

Uncomplicated UTI- cystitis only

(not for skin/soft tissue)

78
Q

Metronidazole & Nitrofurantoin- MOA?

A

Inhibits protein synthesis -> cell death

79
Q

Metronidazole- side effects?

A

Contraindicated w/ alcohol / propylene glycol-containing products during/within 3days of treatment or d/c

80
Q

Nitrofurantoin- side effects?

A

Brown urine

Contraindicated if CrCl <60mL/min

81
Q

Ciprofloxacin & Levofloxacin - MOA?

A

Inhibits DNA replication

82
Q

Pneumonia bacterias?

A

CAP:
Streptococcus pneumoniae
Haemophilus influenzae
Staphylococcus aureus

Atypical:
Legionella pneumophila

83
Q

CAP (no comorbidities) regimen?

A

Amoxicillin

Doxycycline

Macrolide- azithromycin (if local resistance < 25%)

84
Q

CAP (with comorbidities) regimen?

A

Amoxicillin/clavulanate

Cephalosporin AND
Macrolide (azithromycin) OR Doxycycline

Monotherapy w/ respiratory fluoroquinolone (Levofloxacin)

85
Q

General standard regimen for CAP, inpatient?

A

Penicillin OR Cephalosporin
AND
Macrolide (azithromycin)

or

Respiratory Fluroquinolone- levofloxacin

86
Q

Bacterial rhinosinusitis- how long are Sx felt?

A

> 10days w/o improvement

87
Q

Bacterial rhinosinusitis- what bacteria causes?

A

Streptococcus pneumoniae
Haemophilus influenzae

88
Q

Bacterial rhinosinusitis- treatment?

A

First line:
Amoxicillin/clavulanate (preferred) or
Amoxicillin

Penicillin allergy:
Doxycycline (not for kids)
3rd gen cephalosporin (cefdinir- PO)
Respiratory fluoroquinolone (levofloxacin)

89
Q

Acute otitis media- what bacteria causes?

A

Streptococcus pneumoniae

90
Q

Acute otitis media- treatment?

A

First line:
Amoxicillin or
Amoxicillin/clavulanate (if other recurrences/risk factors calling for broader coverage)

Penicillin allergy:
Cefdinir

91
Q

UTI- what bacteria causes?

A

E. coli, other enterobacteria
Staphylococcus saprophyticus
Pseudomonas aeruginosa

92
Q

Cystitis vs. Pyelonephritis Sx?

A

Cystitis (local):
Increased frequency/urgency
Nocturia
Dysuria
Hematuria

Pyelonephritis (systemic):
Flank pain
Abdominal pain
Nausea/Vomiting
Fever
Malaise

93
Q

UTI/Cystitis- treatment?

A

First line:
Trimethoprim (TMP) / Sulfamethoxazole (SMX)
Nitrofurantoin

Alternatives:
Ciprofloxacin
Levofloxacin
B-Lactams

94
Q

Skin and Soft Tissue Infections (cellulitis)- what bacteria causes?

A

Staphylococcus aureus
Streptococcus pyogenes
Pseudomonas aeruginosa

94
Q

Pyelonephritis- treatment?

A

First line:
Ciprofloxacin
Levofloxacin
Trimethoprim (TMP) / Sulfamethoxazole (SMX)

Alternatives (not preferred):
B-lactams

MRSA coverage:
Vancomycin or linezolid

95
Q

Cellulitis, mild- treatment?

A

Penicillin PO
Cephalosporin PO

96
Q

Cellulitis, moderate- treatment?

A

Penicillin IV
Ceftriaxone (3rd gen)
Cefazolin (1st gen)

97
Q

Cellulitis, severe- treatment?

A

Vancomycin AND Piperacillin/Tazobactam

98
Q

C. diff- risk factors/testing?

A

New/Unexplained >3unformed stools in 24hr

Prior antibiotics within 90days

99
Q

C. diff- initial treatment?

A

Vancomycin
Metronidazole

100
Q

C. diff- first recurrence treatment?

A

Vancomycin

101
Q

C. diff- further recurrent treatment?

A

Vancomycin

Fecal Microbiota Transplantation “gold standard” for recurrences

102
Q

C. diff- fulminant treatment?

A

Vancomycin AND
Metronidazole

103
Q

GBS- treatment?

A

Ampicillin
Penicillin G

Neonatal: ampicillin & aminoglycoside (gentamicin)

104
Q

STI- bacteria that causes & treatment?

A

Chlamydia- Doxycycline (azithromycin, levofloxacin)

Gonorrhea- Ceftriaxone

Syphilis- Penicillin G (doxycycline- if true PG allergy)

Trichomoniasis- Metronidazole

Bacterial Vaginosis- Metronidazole (clindamycin)

Adv. Pharm (9 decks)

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