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Pharmacology Exam 1 > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Azithromycin (Zithromax; Z-pak)

A

PO/IV

Macrolide

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2
Q

Clarithromycin (Biaxin)

A

PO
Macrolide
SE: GI upset

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3
Q

Erythromycin (E-Mycin)

A

PO/IV
Macrolide
little h.flu coverage
SE: GI upset, QT prolongation

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4
Q

Erythromycin 0.5% ointment

A

Macrolide - opthalmic
Prophylaxis opthalmia neonatorum
conjunctivitis (q 4-6 hrs)

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5
Q

Azithromycin 1.0% solution (AzaSite)

A

Macrolide - opthalmic
conjunctivitis >1 year old
dosing: bid then qd (more convenient than e-mycin)
Store in refrigerator

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6
Q

Beta-Lactams MOA

A
  • Targets cell membrane
    1. Inhibits the enzyme transpeptidase (pcn binding protein), causes lysis of the cell.
    2. bacteriocidal
    3. time dependent
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7
Q

Beta-Lactams - General uses

A

pharyngitis (esp. GABHS), prevention of rheumatic heart disease and syphilis

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8
Q

Neurosyphilis DOC

A

Aqueous PCN G

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9
Q

Aqueous PCN G

A

Beta Lactam Penicillin
IV/IM
Adult: 0.5-4 MU q 4 hrs
Peds: weight based

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10
Q

PCN VK

A

Beta Lactam Penicillin

only PO

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11
Q

Benzathine PCN G (Bicillin)

A

Beta Lactam Penicillin
IM
Adult: 2.4 MU x 1

*make sure has tolerated PCN before because the dose lasts a long time

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12
Q

Why should you not use PCN in staph cellulitis?

A

because staph produces penicillin-ase that neutralizes the drug (use PCN-ase resistant PCN instead)

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13
Q

Beta Lactams - side effects

A

anaphylaxis
rash
nausea
seizure

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14
Q

Penicillinase-Resistant PCNs - spectrum

A

NARROWED spectrum to staph (aureus and epidermidis)

mostly for cellulitis and endocarditis

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15
Q

Dicloxacillin (Dycill; Pathocil)

A

BL: PCNase resistant
PO (empty stomach)
QID
MSSA only

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16
Q

Nafcillin (Unipen)

A

BL: PCNase resisitant
IV (burns)
4-6 times a day
MSSA

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17
Q

Oxacillin (Bactocil)

A

BL: PCNase resistant
IV/IM
PCN-ase resistant
Used in Lab to test for resistance (MRSA)
Not used much b/c of SE (renal and liver)

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18
Q

Aminopenicillins - coverage

A

expanded gr-
“HELPS” - h.flu, e.coli, listeria, proteus, salmonella/shigella
Good activity against PCN-resistant strep pneumo
*Enterococcus

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19
Q

Aminopenicillins - General uses

A

OM, sinusitis, lower UTI, Shigella, Salmonella, h.pylori, listeria

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20
Q

Listeria (meningitis) DOC

A

Ampicillin

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21
Q

GBS prophylaxis for delivery DOC

A

Ampicillin or PCN

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22
Q

Ampicillin

A

Aminopenicillin
PO/IV q6
SE: rash (especially if give for viral/mono infection)
Renal dosing

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23
Q

Amoxicillin (Amoxil)

A

Aminopenicillin
PO q8
SE: rash (especially if given for viral/mono)
PO dosing provides better absorption and less frequent administration improves compliance

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24
Q

Shigella DOC

A

Ampicillin

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25
Q

Salmonella DOC

A

Amoxicillin

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26
Q

Extended Spectrum Penicillins (Beta Lactam) - spectrum

A

extended to cover pseudomonas and enterobacter
“Treats Pseudomonas”
Ticarcillin, Piperacillin

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27
Q

Beta Lactam/Beta Lactamase Inhibitor (BLI)

A

BLIs inhibit the enzymes that bacteria produce that inactivate the beta-lactam antibiotic. Given with some beta lactams to decrease resistance.

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28
Q

What are the 3 BLIs?

A

SUB - sulbactam
CA - clavulanic acid
TZ - tazobactam

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29
Q

Amoxicillin/CA (Augmentin)

A

Extended spectrum PCN
Only PO option (q 8-12)
renal dosing
*no pseudomonas

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30
Q

Ampicillin/SUB (Unasyn)

A 
IV/IM q 6-8
Extended spectrum PCN
*no pseudomonas
Covers anaerobes
Best of this group for enterococcus
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31
Q

What are the extended spectrum penicillins for enterococcus?

A

Ampicillin/SUB (Unasyn)

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32
Q

Ticarcillin/CA (Timentin)

A

Extended spectrum PCN
IV/IM q 4-8
Pseudomonas
renal dosing

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33
Q

Piperacillin/TZ (Zosyn)

A

Extended spectrum PCN
IV/IM q 4-6
pseudomonas
renal dosing

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34
Q

What are the extended spectrum penicillins for pseudomonas?

A

Ticarcillin/CA and Piperacillin/TZ

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35
Q

Cephalosporin (Beta Lactam) - general info

A

bacteriocidal

5 generations - each generation sees greater gr- coverage and CNS penetration

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36
Q

What 3rd generation cephalosporin common causes brick red or maroon stool?

A

Cefdinir (Omnicef)

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37
Q

What 3rd generation cephalosporin covers pseudomonas?

A

Ceftazidime (Fortaz)

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38
Q

Monobactams (Beta Lactam) - spectrum

A

“MONObactams only cover 1 type of bacteria which can be ‘negative’” (gram negative only)

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39
Q

Monobactams - general uses

A

UTIs, skin infections, pneumonia, intrabdominal infections, septicemia, gyn infections

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40
Q

Aztreonam (Azactam)

A

Monobactam
IV 1-2 g q 8-12 hrs
SE: phlebitis, rash, elevated liver enzymes

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41
Q

Carbapenems (Beta Lactam) - spectrum

A

multi-drug resistant pathogens and pseudomonas (except ertapenem)
Similar to 4th gen cephlasporins in coverage

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42
Q

Which carbapenem does NOT cover pseudomonas?

A

ertapenem

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43
Q

Carbapenems - general uses

A

UTIs, febrile neutropenia, soft tissue infections, bacterial meningitis (>3 mos old)

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44
Q

Carbapenems

A

imipenem (primaxin) IV
ertapenem (Invanz) IM/IV (no pseudomonas)
doripenem (doribax) IV
meropenem (merrem) IV/IM
SE: up to 50% of pts allergic to PCN are allergic to carbapenems
renal dosing

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45
Q

Vancomycin - IV or PO?

A

PO for c.diff only (doesn’t absorb - too big!)

IV for MRSA

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46
Q

Vancomycin - C.diff treatment

A 
wash hands with soap/water, alcohol does not kill
#1 Metronidazole 500mg po tid x 10-14 days (for 1st/2nd mild-moderate infections)
#2 Vancomycin 125 mp PO qid x 10-14 days (severe infection)
#3 vancomycin 500 mg po qid for servere +/_ metronidazole IV (if inflaned colon or complete ileus)
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47
Q

Telavancin (Vibativ)

A

IV
Lipoglycopeptide
complicated skin and skin structure infections (cSSSI) caused by: MRSA, strep pyogenes, strep agalactiae, enterococcus faecalis)
renal dosing
SE: taste disturbances (soap/metal), nephrotoxic, QT prolongation
Preg C but there is concern
Expensive

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48
Q

Macrolides and Ketolide MOA

A

inhibit protein synthesis by binding to domain II and V on the ribosomal subunit

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49
Q

Telithromycin (Ketek)

A

PO
Ketolide
s.pneumoniae, CAP, bronchitis, sinusitis, s.aureus, h.flu, atypicals
CYP3A4 inhibitor
renal adjust
hepatotoxic
*Lots of issues: FDA, renal dosing, side effects –> not used much anymore

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50
Q

Tetracyclines - MOA

A

bind to the 30S ribosomal subunit and interfere with translocation reaction

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51
Q

Tetracyclines - general uses

A

Anthrax, CAP, acne, tick born diseases

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52
Q

Tetracycline (Sumycin)

A

PO
SE: yellowing teeth/decreased bone growth in peds, phototoxicity, GI, esophageal ulcerations
di and trivalent cations decrease absorption

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53
Q

Minocycline (Dynacin; Minocin; Solodyn)

A 
PO (empty stomach)/IV
Tetracycline
ADE: blue gray staining of teeth
CA-MRSA
renal adjust
di and trivalent cations reduce absorption
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54
Q

What is the Preg category for all tetracyclines?

A

D

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55
Q

Doxycycline (Vibramycin)

A 
PO/IV
Tetracycline
MRSA
*no renal adjustment
phototoxicity
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56
Q

What is the only tetracycline that does not require renal adjustment?

A

Doxycycline

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57
Q

What class of drugs is used to treat tick borne illnesses like Lyme and RMSF?

A

Tetracyclines

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58
Q

Which antibiotics (general) cover gr+?

A

All except tetracyclines and metronidazole

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59
Q

Which antibiotics (general) cover gr-?

A

All except daptomycin, clindamycin and metronidazole.

60
Q

Which antibiotics cover atypicals?

A

*macrolides

Newer fluoroquinolones,tetracyclines

61
Q

Dental prophylaxis - DOC

A

AMX

If PCN allergy: macrolide

62
Q

If someone is PCN allergic, what is usually the next option?

A

Macrolide (azithromycin, clindamycin, clarithromycin, etc.)

63
Q

What is the concern the PCN Benzathine?

A

IM - want to make sure pt has had PCN before and tolerated well. Lasts a long time!

64
Q

Doxycycline DDI

A

Di and trivalent cations…ca, mg, al, fe. Separate by 2-4 hrs

65
Q

Tetracycline - dental effects

A

Not used in utero or <8 yrs
Causes permanent staining - yellow or gray to brown
Tetracycline binds to calcium during mineralization. When exposed to light, starts as Fluorescent yellow to brown over months-yrs.

66
Q

Minocycline - dental effects

A

All ages
Blue gray, does not fluoresce
Why? Drugs binds to collagen and drug etches enamel (from saliva)
<100mg/day can decrease risk

67
Q

What are the drugs in the PCN group?

A

PCN G
PCN VK
Benzathine

68
Q

What are the drugs in the Penicillinase resistant group?

A

Dicloxacillin
Nafcillin
Oxacillin

69
Q

What are the aminopenicillins?

A

Ampicillin

Amoxicillin

70
Q

2nd gen cephalosporins - Coverage

A

Better gram negative
HEN PECKS
H.influenza, E. coli, n. Meningitis and gonorrhea, proteus, klebsiella, serratia marascens

71
Q

Ceftriaxone - DDI

A

Contraindicated with calcium in neonates

72
Q

5th generation cephalosporins - coverage

A

Improved gram + esp. PCN resistant strep and MRSA

73
Q

Monobactam if PCN allergic?

A

Yes, OK

74
Q

Carbapenems if PCN allergic?

A

Caution! Up to 50% are also allergic

75
Q

Carbapenems - biggest ADE?

A

Seizure - esp. with imipenem

76
Q

Vancomycin - ADE

A

Ototoxic
Nephrotoxic
Thrombophlebitis

77
Q

Vancomycin - monitoring of levels

A

Troughs most important (time dependent killer)

10-20 (15-20 if MRSA)

78
Q

Vancomycin - 2 uses

A

MRSA

C.diff

79
Q

Telavancin - use

A

Complicated skin infection - MRSA, strep pyogenes,enterococcus, strep agalactiae

80
Q

Telavancin - ADE

A

Taste disturbances (metal soapy)
Nephrotoxic
Ototoxic
C.diff

81
Q

Why don’t beta lactams work for mycoplasma Pneumonia?

A

Because it works on the cell wall and m. Pneumo has no cell wall

82
Q

Tetracyclines - what drugs?

A

Tetracycline
Minocycline
Doxycycline

83
Q

What drug class can treat anthrax?

A

Tetracyclines

84
Q

Anaerobic agent

A

Clindamycin (cleocin)

85
Q

Clindamycin - unique property

A

Especially good for pneumo with abcess and anaerobes

86
Q

Which abx has clinical properties similar to macrolides?

A

Clindamycin

87
Q

Which abx, besides macrolides, is a good alternative to PCN?

A

Clindamycin

88
Q

Dietary restriction: Linezolid

A

No aged cheeses

89
Q

DDI Linezolid

A

MAO inhibitor properties

90
Q

Which abx are considered ototoxic?

A

Aminoglycosides
Telavancin
Vancomycin

91
Q

What can be done to decrease potential of ototoxicity with certain drugs?

A

Try to limit to one

Don’t give too much or for too long

92
Q

Which carbapenem requires co-administration of cisplatin in order to remain active?

A

Imipenem

93
Q

Which macrolide is used for h.pylori and uncomplicated skin, URI and LRI?

A

Clarithromycin

94
Q

What is the most common side effect of erythromycin?

A

GI toxicity

95
Q

Ciprofloxacin DDI

A

Calcium

Teaching - separate by 2 hours

Why? Ca increases gastric ph, causes ciprofloxacin to become negatively charged, absorption is reduced.

96
Q

Which fluoroquinolones are not used for UTIs?

A

Moxifloxacin and gemifloxacin - don’t get into bladder in high enough concentrations

97
Q

FQs - ADE

A

NSAIDs - increase seizure risk

Should avoid FQs if seizure risk (epilepsy, etc.) or lower seizure threshold (certain meds, renal dysfunction, etc.)

98
Q

Linezolid - ADE

A

Anemia (up to 94% platelet reduction in some cases!)

99
Q

Itraconazole (capsules) -DDI

A

Proton pump inhibitors - needs acid environment

100
Q

FQs - di and trivalent cations

A

Avoid +/- 2 hours

101
Q

What is the only FQ that is used in Peds?

A

Ciprofloxacin for CF

102
Q

Can Vitamin C decrease tooth staining with Tetracycline and Minocycline?

A

No. May actually increase with Minocycline.

103
Q

DDI - fluoroquinolones and tetracyclines

A

Dinand trivalent cations (Al, Ca, Mg)

104
Q

Which BLs are 3A4 inhibitors?

A

Erythromycin and clarithromycin

105
Q

What is the only infection telithromycin is used for?

A

MDR strep pneumo

106
Q

Which abx classes are contraindicated in pregnancy?

A

Tetracyclines and fluoroquinolones

107
Q

Which abx classes are contraindicated in peds?

A

FQ (tendon rupture) and tetracyclines (dental)

108
Q

Why are FQs contraindicated in peds?

A

Binds with tendons…rupture possible

109
Q

DDI Metronidazole

A

Coumadin (2C9)

110
Q

DDI Bactrim

A

Coumadin (2C9)

111
Q

What is the only BL for h.pylori?

A

Clarithromycin

112
Q

Are BLs bactericidal or bacteriostatic?

A

bacteriocidal

113
Q

Are BLs time dependent or concentration dependent killers?

A

time dependent

114
Q

Which 2 abx effect cell wall but are NOT BLs?

A

Vancomycin and Telavancin

115
Q

Conjunctivitis DOC

A

Azithromycin > 1 yr old (bid then qd - easier dosing)

alt. - Erythromycin (q 4-6 hrs)

116
Q

Penicillins - genearl uses

A

gr + (strep)
gr- aerobes (n.meningitis and pasteurella)
anaerobes (clostridium and some bactericides)
syphillis

117
Q

Penicillins - type of elimination

A

renal

118
Q

BL - Pregnancy considerations

A

all ok

119
Q

Extended spectrum PCN - renal consideration

A

all need renal dosing except Amp/SUB (Unasyn)

120
Q

Aminopenicillins - renal consideration

A

renal dosing

121
Q

What abx class is a good choice for URI?

A

Aminopenicillins - Amp, Amx

122
Q

h.pylori treatment

A

PPI + Clarithromycin + Amx

123
Q

Which aminopenicillin is used to treat h.pylori?

A

Amx

124
Q

What 4th generation cephalosporin covers pseudomonas?

A

Cefipime

125
Q

Which aminopenicillin gets better absorption and therefore can be administered less frequently (improved compliance)?

A

Amx

126
Q

Are BLIs antimicrobial?

A

No. They protect the antibiotic. The BLI takes the hit from the bug so the abx is safe and can do it’s job.

127
Q

If you are using Piperacillin or Ticarcillin for pseudomonas, can you switch to Augmention for po at home?

A

No. Augmentin does not cover pseudo. Must switch class…FQ, Cephalo, etc.

128
Q

1st generation cephalosporins

A

PO - Cephalexin (Keflex)

IV - Cefazolin (Ancef)

129
Q

1st generation cephalosporins - coverage

A

MSSA, some PCN-susceptible anaerobes, little gr -

130
Q

2nd generation cephalosporins

A

PO: Cefuroxime axetil (Ceftin), Cefprozil (Cefzil), Loracarbef (Lorabid)
IV: Cefoxitin (Mefoxin) and Cefotetan (Cefotan)

131
Q

3rd generation cephalosporins (+ pseudomonas)

A

PO: cefidinir (omnicef)
IV: ceftazidime (fortaz) *pseudomonas

132
Q

4th generation cephalosporin - one drug

A

IV: Cefepime (Maxipime)
*pseudomonas
reserved for severe infections

133
Q

5th generation cephalosporins - one drug (+ MRSA)

A

IV: Ceftaroline fosamil (Teflaro)

no pseudo

134
Q

Vancomycin - MOA

A

inhibits the linking of transpepsidase - blocks the enzyme

*effects cell wall but by different action

135
Q

Macrolides - Bacteriostatic or Bacteriocidal?

A

bacteriostatic

136
Q

Which ABX group is effective ONLY against gram- ?

A

Monobactam

137
Q

Which ABX groups are effective against gr+ only?

A

PCNase, Ceph 1st gen, Vanc, Telavancin

138
Q

Which ABX groups are effective against anaerobes?

A

PCN, Extended-spectrum, BL/BLI, Ceph 2nd, Carbapenems, Vanc

139
Q

Which ABX groups are effective against pseudomonas?

A

Extended-spectrum, BL/BLI, Ceph 3rd/4th, Monobactam, Carbapenem (not erta)

140
Q

Which ABX groups are effective against MRSA?

A

Vanc, Telavancin, Ceph 5th,

141
Q

Which ABX groups are effective against enterococcus?

A

PCN, Aminopenicillins, BL/BLI, Vanc, Telavancin

142
Q

Which receptor do some FQs modulate which may increase risk for seizures?

A

GABA

143
Q

Linezolid ADE

A

thrombocytopenia

Why? because binds with platelet glycoprotein receptors and makes the complex antigenic

144
Q

Which FQ has increased seizure risk?

A

Cipro

145
Q

Levoquine DDI

A

Fe

binds and can cause therapeutic failure

Pharmacology Exam 1 (19 decks)

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