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antibiotics 2 Flashcards

1
Q

importance of D-alanine

A

amino acid that combines with other amino acids to create a polypeptide that helps the peptidoglycan unit attach to other PG units, leading to PG later of cell wall

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2
Q

vancomycin

A

glycopeptide

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3
Q

telavancin

A

glycopeptide

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4
Q

what abx inhibits cell wall synthesis by binding to D-ala D-ala and prevents the formation of peptidoglycan and phospholipids

A

glycopeptides
bactericidal

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5
Q

how are we seeing resistance against glycopeptides

A

alternation of binding site to D-ala-D-Lac
seen in VRE

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6
Q

what type of bacteria does vancomycin kill?

A

g+
NO G-

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7
Q

Main indications of vancomycin

A

S. aureus (MRSA)
Clostridium (C. diff)

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8
Q

what is the main tx of MRSA for inpatient therapy

A

vancomycin

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9
Q

you must adjust vancomycin for…

A

renal impairment

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10
Q

vancomycin dosing is based upon…

A

CrCL and TBW
impaired renal function = less frequent dosing intervals

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11
Q

how do you monitor vancomycin for severe MRSA infections

A

area under the curve (AUC) calculations

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12
Q

using vancomycin for other infection (not severe) you base the dosing based upon…

A

trough levels

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13
Q

when is vancomycin monitoring not needed?

A

uncomplicated skin/soft tissue infections in non-obese pts who have normal renal function

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14
Q

trough level adjustments of vancomycin is measured ____ prior to next infusion after steady state is reached

A

30 mins
normal renal function - after 4th dose
impaired - assess “spot” serum conc until renal function stabilizes

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15
Q

for AUC level adjustments for vancomycin, trough levels are obtained _____, peak levels are obtained ______

A

30 mins before dose
1-2hrs after dose

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16
Q

adverse effects of vancomycin

A
  1. hyperemia (Red man syndrome)
  2. nephrotoxicity/ototoxicity
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17
Q

how do you avoid hyperemia when using vancomycin

A

do slow infusions (1-2h)

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18
Q

what can you give to preteat hyperemia when prescribed vancomycin

A

antihistamines

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19
Q

nephrotoxicity/ototoxicity is more likely with vancomycin when it’s combined with ?

A

aminoglycosides

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20
Q

what alternatives of vancomycin can be used for MRSA infections

A
  1. televancin - no VRE
  2. dalbavancin - no VRE
  3. oritavancin
  4. daptomycin
  5. linezolid
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21
Q

what alternative use of vancomycin is also the best choice for VRE infection

A

daptomycin

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22
Q

gentamicin

A

aminoglycoside

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23
Q

tobramycin

A

aminoglycoside

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24
Q

amikacin

A

aminoglycoside

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25
Q

streptomycin

A

aminoglycoside

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26
Q

MOA of aminoglycosides

A

inhibits bacterial protein synthesis - binds to the 30S subunit
bactericidal

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27
Q

4 modes of resistance of aminoglycosides

A
  1. chromosomal mutation
  2. enzymatic destruction of drug
  3. lack of permeability through cell wall
  4. efflux pump
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28
Q

spectrum of aminoglycosides

A

g-
mycobacterium tuberculosis
NO G+

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29
Q

Aminoglycosides are most frequently used in combo with ?

A

aminoPCN
(ampicillin + gentamicin)

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30
Q

how do you monitor aminoglycosides?

A
  1. monitor peak and troughs
  2. BUN/Cr
  3. audiometry

same precautions as vancomycin

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31
Q

doxycycline

A

tetracycline

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32
Q

minocycline

A

tetracycline

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33
Q

MOA of tetracyclines

A

inhibits bacterial protein synthesis - binds to 30S ribosomal subunit, blocks tRNA
bacteriostatic

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34
Q

2 modes of resistances of tetracyclines

A
  1. active efflux
  2. enzymatic deactivation
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35
Q

spectrum of tetracyclines

A
  1. g+
  2. g-
  3. atypicals - mycoplasma, rickettsiae, chlamydiae, spirochetes

includes MRSA

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36
Q

first line and additional treatments of tetracyclines

A
  1. lyme disease
  2. rocky mountain spotted fever
  3. cholera
  4. acne

additional - chlamydia, CAP (empiric)

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37
Q

contraindications for tetracyclines

A
  1. children <8-9 y/o (<13 not as bad)
    - tooth discoloration
  2. pregnancy/nursing
    - hepatotoxicity
    - tooth discoloration (baby)
    - fetal long bone growth impairment
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38
Q

what should you avoid while taking tetracyclines

A
  1. antacids
  2. dairy products
    limits absorption
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39
Q

adverse effects of tetracyclines

A
  1. GI distress
  2. hepatotoxicity
  3. photosensitivity
  4. vertigo - especially minocycline
  5. C. diff
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40
Q

erythromycin

A

macrolide

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41
Q

azithromycin

42
Q

clarithromycin

43
Q

MOA of macrolides

A

inhibits protein synthesis and translocation via 50s subunit
bacteriostatic

44
Q

3 methods of resistance of macrolides

A
  1. 50s subunit target modification
  2. efflux pumps
  3. degradation enzymes
45
Q

spectrum of macrolides

A
  • very broad
    1. g+ - including s. pneumoniae
    2. g-
    3. atypicals
46
Q

first line treatments of macrolides

A
  1. CAP
    - atypicals: mycoplasma, chlamydia
  2. chlamydia
  3. legionella
  4. diphtheria
  5. COPD
47
Q

what is the preferred treatment for sinusitis

48
Q

which macrolide is not as strong of a CYP450 inhibitor

A

azithromycin

49
Q

adverse SE of macrolides

A
  1. GI
  2. hepatotoxicity
  3. prolonged QT interval
  4. ototoxicity
50
Q

what other medications should be used with caution when taking macrolides?

A

antihistamines
antidepressants
antifungals
all also prolong QT interval

51
Q

MOA of clindamycin

A

inhibits protein synthesis via 50S

52
Q

spectrum of clindamycin

A
  1. g+ (including MRSA)
  2. anaerobes
53
Q

common indications for clindamycin (3)

A

oral abscesses
BV
MRSA skin infections

54
Q

SE of clindamycin

A

N/D, rashes

55
Q

BBW of clindamycin

A

C diff colitis
take probiotic

56
Q

ciprofloxacin

A

quinolones

57
Q

levofloxacin

58
Q

moxifloxacin

59
Q

which abx inhibits DNA synthesis by interfering with DNA gyrase and topoisomerase IV

A

quinolones
bactericidal

60
Q

3 methods of resistance of quinolones

A
  1. mutation in chromosomal genes
  2. efflux pumps
  3. decreased cell wall permeability
61
Q

spectrum of quinolones

A

broad:
- better g- > g+ - moxi and levo have better g+
- g+: streptococcus, MSSA
- anaerobes = moxi

62
Q

what quinolones have better g+ coverage

A

levofloxacin, moxifloxacin

63
Q

what quinolone has anaerobic coverage

A

moxifloxacin

64
Q

first line treatments of quinolones?

A
  1. otitis externa, ophthalmic infections (topical cipro/levo only)
  2. URI/pneumonia with comorbidities (levo, moxi)
  3. diarrhea (cipro)
  4. pyelonephritis (cipro)
  5. prostatitis (cipro)
  6. anthrax (cipro)
65
Q

PK of quinolones

A

strong CYP450 inhibitor

66
Q

contraindications for quinolones

A
  1. prolonged QT/arrhythmias
  2. myasthenia gravis
67
Q

what abx has a BBW of tendinitis/tendon rupture?

A

quinolones

68
Q

SE of quinolones

A
  • nephrotoxicity
  • lower seizure threshold
  • C. diff
  • hepatotoxicity
  • photosensitivity
69
Q

what abx works as a folate reductase inhibitor

A

trimethoprim
bacteriostatic

70
Q

what abx works as a folate synthesis inhibitor

A

sulfamethoxazole
bacteriostatic

71
Q

spectrum of trimethoprim/sulfamethoxazole

A

Mostly g-
some g+
includes MRSA

72
Q

first line treatments for trimethoprim/sulfamethoxazole

A
  1. outpatient for MRSA
  2. UTI
  3. prophylaxis and prevention of P.jiroveci

additional - legionella and certain pneumonias

73
Q

SE of trimethoprim/sulfamethoxazole

A
  1. megablastic anemia (folic acid deficiency )
  2. photosensitivity
  3. heptatoxicity
74
Q

what abx only functions as a urinary antiseptic

A

nitrofurantoin (macrobid/macrodantin)

75
Q

MOA of nitrofurantoin (macrobid/macrodantin)

A

inhibits bacterial enzymes and damages DNA

76
Q

coverage of nitrofurantoin (macrobid/macrodantin)

A

E. coli/e. faecalis

77
Q

first line for nitrofurantoin (macrobid/macrodantin)

78
Q

caution with nitrofurantoin (macrobid/macrodantin)

A
  1. pregnancy
    - neonatal jaundice
    - tetratogenicity - first trimester, up to 14 weeks gestation
  2. severe renal impairment
79
Q

most common SE of nitrofurantoin (macrobid/macrodantin)

80
Q

metronidazole

A

nitroimidazole

81
Q

tinidazole

A

nitroimidazole

82
Q

MOA of nitroimidazole

A

disrupts microbial DNA - Causes loss of DNA helical structure and strand breakage

83
Q

first line tx of metronidazole (flagyl)

A
  1. trichomonas
  2. BV
  3. C. diff
84
Q

PK of metronidazole

A

minor inhibitor CYP450
does not cause many drug reactions

85
Q

SE of metronidazole

A
  1. metallic taste
  2. disulfiram-like reaction
86
Q

what do you need to avoid when taking matronidazole

87
Q

what abx has a BBW of carcinogenic in mice and rats

A

metronidazole

88
Q

what abx is a folate synthesis inhibitor, used as a topical for burns

A

silver sulfadiazine (silvadene)

89
Q

what abx is a folate synthesis inhibitor used as a tx for opthalmic infections

A

sulfacetamide

90
Q

what folate reduction inhibitor is used for antiparasite/antimalarial

A

pyrimethamine

91
Q

what abx is limited to topical application only due to nephrotoxicity

A

bacitracin
active against g+

92
Q

what abx is mainly used for pseudomonas in the eye/mainly ophthalmic drops

A

polymyxin B
g- coverage, ophthalmologic uses due to toxicity

93
Q

what is the main abx for impetigo

A

mupirocin
used combo with chlorhexidine to decolonize MRSA carriers

94
Q

what DNA/protein synthesis abx have pseudomonas coverage

A

cipro
levo
aminoglycosides
polymyxin B

95
Q

what DNA/protein synthesis abx have MRSA coverage

A
  1. vancomycin
  2. tetracycline
  3. clindamycin
  4. trimethoprim/sulfamethoxazole
  5. mupirocin
96
Q

what DNA/protein synthesis abx have anaerobic coverage

A
  1. clinda
  2. moxifloxacin
  3. nitroimidazoles
  4. chloramphenicol
97
Q

what DNA/protein synthesis abx have atypical coverage

A
  1. tetracyclines
  2. macrolides
98
Q

what DNA/protein synthesis abx have VRE coverage

A
  1. vancomycin
  2. daptomycin
  3. oritavancin
  4. linezolid
99
Q

what DNA/protein synthesis abx have VRE coverage

A
  1. vancomycin
  2. daptomycin
  3. oritavancin
  4. linezolid
100
Q

all protein synthesis abx are bacteriostatic EXCEPT

A

aminoglycosides

Infectious disease (15 decks)

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