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Resp II > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

natural penicillins

A

penicillin G

penicillin V

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2
Q

anti-staph penicillins

A

oxacillin
dicloxacillin
nafcilin

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3
Q

aminopenicillins

A

ampicillin

amoxicillin

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4
Q

anti-pseudomonal penicillins

A

tricarcillin

piperacillin

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5
Q

1st gen cephalosporins

A

cefazolin

cephalexin

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6
Q

2nd gen cephalosporins

A

cefoxitin

cefuroximne

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7
Q

3rd gen cephalosporins

A

ceftriaxone

ceftazimine

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8
Q

4th gen cephalosporin

A

cefepime

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9
Q

carbapenems

A

imipenem/cilastatin
meropenem
ertapenem

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10
Q

b-lactamase inhibitors

A

ampicillin-subactam
amoxicillin-clavulanic acid
piperacillin-taxobactam

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11
Q

glycopeptides

A

vancomycin

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12
Q

fluroquinolones

A

ciprofloaxin
levofloxacin
moxifloxacin

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13
Q

aminoglycosides

A

amikacin
tobramycin
gentamicin

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14
Q

tetracyclines and glyclcyclines

A

minocycline
doxycycline
tigecycline

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15
Q

macrolides and ketolides

A

clarithomycin
axithromycin
telithromycin

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16
Q

lincosamides

A

clindamycin

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17
Q

streptogramins

A

quinipristin/dalfopristin

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18
Q

oxazolidinoes

A

linezolid

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19
Q

polymyxins

A

colistin

polymyxin B

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20
Q

lipopeptides

A

daptomycin

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21
Q

sulfonamides and trimethoprim

A

sulfamethozazole/trimiethoprim

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22
Q

urinary tract antiseptics

A

methenamine

nitrofurantoin

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23
Q

MIC

A

minimum inhibitory concentration
lowest concentration of drug required to inhibit growth
determined by CLSI

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24
Q

tests to determine MIC

A

dilution
disk diffusion
optical diffusion

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25
Q

bacteriostatic

A

arrests growth and replication of bacteria

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26
Q

bactericidal

A

kills bacterial

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27
Q

targets of antimicrobials

A 
cell wall synthesis
cell membrane synthesis
synthesis of 30S and 50S ribosome subunits
nucleic acid metabolism
fnx of topoisomerases
folate synthesis
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28
Q

resistance mechansims

A
  • reduced entry of antibiotic into pathogen
  • enhanced export of antibiotic by efflux pumps
  • release of microbial enzymes which destroy antibiotic
  • alteration of microbial proteins that transform pro-drugs to effective drugs
  • alteration of target proteins
  • development of alternative pathways to those inhibited by antibiotics
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29
Q

classification based on

A 
class and spectrum of microorganism it kills
biochemical pathway it interferes with
chemical structure
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30
Q

inhibitors of cell wall synthesis

A 
penicillins
cephalosporins
carbapenems
monobactams
glycopeptides
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31
Q

B-lactams MOA

A

structural analogs of D-Ala-D-Ala

covalently bind penicillin-binding proteins inhibitin the last transpeptidation step in cell wall synthesis

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32
Q

B-lactam resistance

A

structural differences in PBPs
decreased PBP affinity for B-lactams
inability for drug to reach site of action
active efflux pumps
drug destruction and inactivation by B-lactamases

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33
Q

Natural penicillins spectrum

A

highly effective against gram + cocci, but easily hydrolyzed by penicillinase

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34
Q

natural penicillins therapeutic use

A

narrow spectrum

strep pneumoniae pneumonia and menigitis

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35
Q

penicillin V uses

A

strep pyogens, strep viridans (endocarditis), syphilis

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36
Q

anti-staphylococcal penicillins spectrum

A

penicllinase resistant thus agents of choice for staph aureus and staph epidermis that are not methicillin resistant

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37
Q

anti-staphylococcal penicillins uses

A

restricted to infections w/known staph sensitivity

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38
Q

aminopenicillins spectrum

A

extended-spectrum
frequently administered w/b-lactamase inhibitor
gram + and -

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39
Q

aminopenicillin uses

A

URI (S. pyogenes, S. pneumonia, H. influenza)
sinusitis
otitis media
enterococcal infections

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40
Q

anti-pseudomonal penicillins spectrum

A

extends sepctrum to pseudomonas aeruginosa
enterobacter
proteus

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41
Q

anti-pseudomonal penicillins uses

A 
serious gram - infections
hospital acquired pneumonia
immunocompromised
bacteremia
burn infections
UTIs
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42
Q

penicillin adverse effects

A 
allergic rxns
anaphylaxis
interstitial nephritis (rare)
nausea, vomiting, mild-severe diarrhea
pseusomembranous colitis
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43
Q

first generation cephalosproins spectrum

A

good gram + coverage

modest gram - (moraxella, E. coli, klebsiella pneumoniae, P. mirabilis)

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44
Q

first generation cephalosporins uses

A

skin and soft tissue infections

surgical prophylaxis

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45
Q

second generation cephalosporins spectrum

A

somewhat increased activity against gram -, but less active then 3rd generation
subset active against bacteroides fragilis

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46
Q

second generation cephalosporins uses

A

gram neg mixed anaerobic
intra-abdominal infections
PID
diabetic foot infections

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47
Q

third generation cephalosporins

A

less active against gram +
more against enterobacteriaceae
resistance increasing

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48
Q

third generation uses

A

DOC for serious gram - infections (klebsiella, enterobacter, proteus, providencia, serratia, Haemophilus)
DOC for gonorrhea and sever Lyme, meningits

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49
Q

fourth generation cephalosporin spectrum

A

extends beyond 3rd gen psuedomnas

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50
Q

fourth generation uses

A

empirical Tx of nosocomial infections

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51
Q

cephlosporins adverse effects

A

1% cross-reactivity to penicllins
diarrhea
intolerance to alcohol

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52
Q

carbapenems sepctrum

A 
aerobic and anaerobic
gram +
enterobacteriaceae
pesugomonas
acinetobacter
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53
Q

resistant to carbapenems

A

stenotrophomonas maltophilia

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54
Q

carbapenem uses

A 
UTI
LRTIs
intra-abdominal
gynocological
SSTI
bone
joint
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55
Q

carbapenem adverse effects

A

nausea/vomiting
seizures
hypersensativity

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56
Q

monobactam spectrum

A 
gram -
enterobacteria
pseudomonas
H. influenza gonococci
not against gram + or anaerobes
57
Q

monobactam uses

A

allergic to B-lactams

58
Q

B-lactamases class A

A

entended spectrum

most worrisome KPC carbapenemase rapidly emerging in enterobacteriaceae

59
Q

B-lactamases class B

A

Zn dependent enzymess destroys all B-lactams except aztreonam

60
Q

B-lactamases class C

A

active against cephalosporins

61
Q

B-lactamases calss D

A

cloxacillin degrading enzymes

62
Q

B-lactamase inhibitors MOA

A

prevent destruction of B-lactam antibiotics, most active against plasmid encoded bB-lacamases, but inactive against chromosmal B-lactamase induced gram-

63
Q

glycopeptides MOA

A

inhibits cell wall synthesis binding w/high affinity to D-ala-D-ala target to D-alaynl-D-lactate or D-ananyl-D-serine which binds glycopeptides poorly

64
Q

glycopeptides spectrum

A

broad gram +

S. aureus, S. epidermidis, strep, bacillus, corynebacterium, actinomuces, clostrdium

65
Q

glycopeptides resistance

A

gram -

mycobacterium

66
Q

glycopeptides uses

A 
osteomyelitis
endocardits
MRSA
strep
enterococci
CNS infections
bacteremia
orally for clostridium difficle
67
Q

glycopeptides adverse effects

A 
macular skin rash, chills, fever, rash
red-man syndrome (histamine release)
extreme flushing
tachycardia
hypotension
ototoxicity
neprhotoxicity
68
Q

fluroquinolones MOA

A

concentration dependent
targets bacterial DNA gyrase, topoisomerase IV
prevents relaxation of supercoils

69
Q

fluroquinolones resistance

A

mutation in genes encoding DNA gyrase or topisomerase IV

active transport out of cell

70
Q

fluroquinolones spectrum

A 
E. coli
salmonella
shigella
enterobacter
campylobacter
neisseria
pseudomonas
S. aureus
limited coverage of strep
71
Q

fluroquinolones uses

A 
UTI
prostatitis
STI
travelers diarrhea
shigelllosis
bone and joint infections
diabetic foot infection
72
Q

fluroquinolones adverse effects

A 
GI
CNS
rash, photosensitive, 
Achilles tendon rupture
CI in kids
73
Q

30s inhibitors

A

aminoglycosides

tetracyclines

74
Q

50s inhibitors

A

macrolides
chloramphenicol
clindamycin

75
Q

aminoglycosides MOA

A

concentration dependent
binds 30S
disrupts protein synthesis
exhibit post antibiotic effect

76
Q

aminoglycoside resistance

A

AG metabolizing enzymes
impaired transport of drug into cell
altered ribosome

77
Q

aminoglycosides spectrum

A

aerobic gram - bacteria

limited against gram + synergistic bactericidal effects in gram + w/cell wall active agent

78
Q

Aminoglycoside uses

A 
UTI (not uncomplicated)
used if resistant to other agents
seriously ill
pneumonia (Strep and anaerobes)
HAP peritonitis
synergy in bacterial endocarditis
tobramycin inhalation in CF
79
Q

aminoglycosides adverse effects

A

ototoxicity
nephrotoxicity
neuromuscular block and apnea

80
Q

tetracyclines/glycylcyclines MOA

A

bacteriostatic
inhibits bacterial protein synthesis by binding 30s
prevents access of aminoacyl tRNA to acceptor site on mRNA

81
Q

tetracyclines/glyclycyclines resistance

A 
decreased influx
acquisition of energy dependent efflux
ribosomal protection proteins
enzymatic inactivation
all stains of pseudomonas
82
Q

tetracyclin/glycylcyclines spectrum

A 
wide range of aerobic and anerobic gram + and gram -
rickettsia
coxiella burnetii
mycoplasma pneumoniae
chlamydia
legionella
atypical mycobacterium
plasmodium
borrelia
burgdorferi
treponema pallidum
83
Q

tigecycline

A

no proteus and providencia

84
Q

tetracyclin/glycylcyclines uses

A 
CAP
atypical CAP 
community acquired MRSA
ance
rickettsial infections
Q fever
anthrax
85
Q

tetracyclin/glycylcyclines adverse effects

A 
GI
superinfections of C. difficile
photosensitivity
teeth discoloration
thrombophlebits
86
Q

macrolides/ketolides MOA

A

bacteriostatic
binds reversibly to 50s
inhibits translocation

87
Q

macrolides/ketolides resistance

A

drug efflux
ribosomal protection proteins
hydrolysis
ribosomal mutations

88
Q

macrolides/ketolides uses

A 
respiratory infections
alternative of otitis media 
sinusitis
bronchitis
SSTIs
pertussis
gastroentertis
H. pylori
mycobacterium
89
Q

macrolides/ketolides drug interactions

A

CYP3A4 inhibition

prolongs effects of digoxin, warfarin

90
Q

lincosamides MOA

A

binds 50s

91
Q

lincosamides resistance

A

ribosomal methylation

all aerobic gram - bacillli

92
Q

lincosamides spectrum

A 
penumococci
S. pyogens, viridans
Streptococci
MSSA
anerobes (B. fragilis)
93
Q

lincosamides uses

A 
SSTIs
necrotizing SSTIs
lung abscesses
anaerobic lung and pleural space infections
topically for acne vulgaris
94
Q

lincosamides adverse effects

A 
diarrhea
pseudomembranous colitis
skin rashes
reversible increase in aminotransferase activity
potentiate neuromuscular blockade
95
Q

Streptogramins MOA

A

bactericidal, protein synthesis inhibitors, bind 50s

96
Q

streptogramins resistance

A

ribosomal methylase, acetyltransferase inactivation of dalfopristin

97
Q

streptogramins spectrum

A 
gram + cocci
s. peumoniae
beta and alpha hemolytic strep
E. faecium
coagulase + and - staph
atypical organisms (m. pneumoniae, legionella
c. pneumoniae)
98
Q

streptogramins uses

A

vancomycin resistant E. faecium

complicated SSTI by MSSA or S. pyogenes

99
Q

streptogramins adverse effects

A

infusion related pain and phelbitis

arthralgia and myalgia

100
Q

streptogramins drug interactions

A 
CYP3A4 inhibition
anticovulsants
macrolides
some FQs
antidepressents
101
Q

oxazolidinones MOA

A

inhibits protein synthesis

50s

102
Q

oxazolidinones resistance

A

ribosomal mutation

103
Q

oxazolidinones spectrum

A

gram + staph, strep, enterococci, anaerobic, gram + rods

104
Q

oxazolidinones uses

A

VRE faecium
nosocomial penumonia due to MSSA and MRSA
CAP
complicated and uncomplicated SSTI

105
Q

oxazolidinones adverse effects

A

myelosupression
headache
rash

106
Q

oxazolidinones drug interactions

A

weak nonspecific inhibitor of monoamine oxidase

107
Q

inhibitors of cell membrane fnx

A

polymyxins

lipopeptides

108
Q

polymyxins MOA

A

interacts w/phospholipids
disrupts structure of cell membranes
changes permeability

109
Q

polymyxins spectrum

A

restricted to gram -

enterobacter, E. coli, klebsiella, salmonella, pasteurella, bordetella, shigella, P. aeruginosa, acinetobacter

110
Q

polymyxin resistance

A

proteus

serratia

111
Q

polymyxin uses

A

topical, skin, mucous membranes, eye, ear, urinary bladder irrigation, ihalation

112
Q

polymyxin adverse effects

A

nephrotoxicity

mm weakness and apnea

113
Q

lipopeptides MOA

A

binds bacterial membranes -> depolarization, loss of membrane potential -> cell death

114
Q

lipopeptides resistance

A

may be due to changes in cell membrane charge

115
Q

lipopeptides spectrum

A

bacteriacideal
concentration dependent
active against aerobic faculagie and anaerobic gram +

116
Q

lipopeptides uses

A

complicated SSTIs
complicated bacteremia
right sided endocarditis

117
Q

lipopeptides adverse effects

A

msk damage
elevations in creatine kinase
rare rhabdomyolysis

118
Q

metronidazole MOA

A

prodrug, requires reductive activation of nitro grps by susceptible organisms
highly reactive nitro radical anions kill organsims by targeting DNA

119
Q

metronidazole resistance

A

decreased formation of nitro radicals

120
Q

metronidazole spectrum

A 
anaerobic cocci 
anaerobic gram - bacilli
anaerobic spore forming gram + bacilli  
trichomoniasis
amebiasis
giardiasis
helicobacter
campylobacter
121
Q

metronidazole uses

A 
bacterial vaginosis
amebic liver abscess
anaerobic bacterial infections
bones, joints, CNS
C. difficile
Chron's disease
122
Q

metronidazone adverse effects

A

HA, dry mouth, metallic taste
vomiting, diarrhea, abdominal distress
disulfiram effect

123
Q

metronidazone drug interactions

A

induced meta of phenobarbital, prednisone, rifampin, warfarin

124
Q

sulfonamides MOA

A

bacteriostatic, competitive inhibitors of dihyropteroate synthase
prevents bacterial use of PABA for synthesis of folic acid

125
Q

trimethoprim MOA

A

inhibition of microbial dihydrofolate reductase

126
Q

sulfonamide and trimethoprim resistance

A

lower enzyme affinity
decrease permeability or active efflux
alternative pathway or increased production of folic acid

127
Q

sulfonamide and trimethoprim uses

A 
UTI
bacterial prostatitis
bronchitis
shigellosis
travelers diarrhea
salmonella
pneumocystis jiroveci
nocardia
stenotrphomonas maltophilia
DO NOT use in strep pharyngitis
128
Q

sulfonamide and trimethoprim adverse effects

A 
allergic skin rashes
nausea, vomiting
CNS (HA and depression)
photosensitivity 
renal dysfnx
stevens-johnson syndrome
129
Q

sulfonamide and trimethoprim drug interaactions

A

potentiated effects of warfarin

130
Q

methenamine MOA

A

decomposes in water to formaldehyde

131
Q

methenamine resistance

A

nome

132
Q

methenamine spectrum

A

all bacterial

133
Q

methenamine uses

A

not primary drug for actue UTI

134
Q

methenamine adverse effects

A

GI
painful and frequent micturition
albuminuria, hematuria
rashes, low systemic toxicity at usual doses

135
Q

nitrofurantoin MOA

A

highly reactive intermediates damage DNA

bacteria reduce drug more rapidly than mammalian cells

136
Q

nitrofuantoin uses

A

UTI

not recommended for pyleonephritis or prostatitis

137
Q

nitrofuantoin adverse effects

A

nausea, vomiting, diarrhea

course of therapy should not exceed 14 days

138
Q

nitrofuantoin contraindications

A

pregnant women
impaired renal fnx
< 1month

Resp II (15 decks)

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