Antibiotics Flashcards
1
Q
what are some of the advantages of oral administration
A
decreases costless resources, IV, pumps etcpatient preferredreduced phlebitisincreased pt mobilityearlier discharge
2
Q
What is the MOA for Beta-Lactams
A
Bind to pencillin binding proteins and inhibit cell wall synthesis
3
Q
what makes up the class of beta-lactams
A
penicillins, Cephalosporins, beta-lactamase inhibitors, aztreonam
4
Q
what are natural penicillins used for
A
treat pharyngitis, erysipelas and syphillis
5
Q
what is the Jarisch -Herxheimer rxn
A
with treatment of spirochetal inf.reaction due to release of large amount of toxin after bacterial killingFever, Chills, Myalgia
6
Q
What are the 1st Gen cephalosproins
A
Cephalexin-oralCefazolin-IV
7
Q
What are the 2nd Gen cephalosproins
A
Cefuroxime-oralCefoxitin-IV
8
Q
What are the 3rd Gen cephalosproins
A
CefpodoximeCeftriaxone
9
Q
What are the 4th Gen cephalosproins
A
CefepimeCeftaroline
10
Q
What makes cephalosporin activity better
A
they are less susceptible to beta-lactamases giving them broader spectrum of action compared to penicillins
11
Q
what is the spectrum of activity for 1st Gen Cephalosporin
A
SPEcKStaph,Strep(+)Proteus, E. Coli, Klebsiella(-)
12
Q
what is the spectrum of 2nd gen Cephalosproin
A
HMSPEcKStaph, Strep(+)Harmophilus, Morazell Catarrhalis, Proteus, E coli, Kleb (-)
13
Q
What are 1st gen ceph used for
A
UTI, Pharyngitis, mild skin or soft tissue, and upper and lower respiratory tract
14
Q
What does 2nd gen ceph used for
A
sinusitis, pharyngitis, otitis media, lower respiratory tract inf,Cefuroxime- lyme
15
Q
what does 3rd gen cover
A
Strep pneumo (+)Enterobacteriacease, H. influenzae, M. cararhalis (-)
16
Q
what are 3rd gen ceph used for
A
CAP, OM, URI, Meningitis, Neutropenia,
17
Q
what do 4 gen ceph cover
A
Strep and Staph(+)Enterobacreriaxease, H. influ, M catarhalis, Psudomonas aerug,Bacterocides
18
Q
what has the highest incidence of GI effects
A
cefixime
19
Q
what has the lowest incidence of diarrhea
A
cefprozil
20
Q
what has the highest incidence of rash
A
cefaclor
21
Q
what is the benefit of probenicid with cephalosporins
A
increases concentration
22
Q
what are rates of allergic reactions like with chepalosporin
A
low about 1%
23
Q
which generation of chepalosporin have higher risk of reaction
A
1st gen
24
Q
what is a mono bactam an what is their MOA
A
Aztreonambind to penicillin binding protein and inhibit cell wall synthesis which causes cell death
25
what selectivity does Aztreonam have?what type of infections is it good for?What does it need dose adjustment for?what is the cross sensitivity like for it?what are the adverse effects like?
only monobactam in USgram (-) coverage including pseudomonas, does not cover anaerobic or gram (+)Good for resistant infections b/c it is resistant to many beta lactamases produced by gram (-) bacteriadecreased renal functionlow incidence of adverse effects-diarrhea
26
What drugs are part of the carbapems
Imipenem/ CilastatinMeropenemDoripenemErtapenem
27
what is the MOA for carbapenems
bind to penicillin binding protein and inhibit cell wall synthesis which leads to cell death
28
What bacteria are carbapenems good for
resistant to most beta-lactamases and the drug of choice for infection caused by ESBL
29
What do carbapenems cover
Staph, Strep, Listeria (+)Gram (-)anaerobes Pseudomonas except ertapenem
30
what are clinical uses of carbapenems
UTI, lower respiratory infections, intra-abdominal and gynecological infections, skin, soft tissue, bone, and joint inf
31
what are the adverse effects of carbapenems
N/V, seizures-highest with imipenem with pts that have renal failure
32
what drugs are part of the glycopeptide antibiotics
Vancomycin, Telavancin
33
what is the MOA of glycopeptide antibiotics
prevents cross linking of the cell wall peptidoglycan during cell wall synthesis
34
What does Vancomycin cover
gram (+) only
35
what type of infections does Vancomycin cover
MRSA infection- sepsis, endocarditis, meningitis, skin and soft tissue infectionsUSED to treat C. Diff only
36
What is the dosing regimen for Vancomycin
dosing is variable based on body weight and renal function
37
what level should vancomycin be above to prevent resistance
10-20mcg/ml
38
what are the adverse Rxn of vancomycin
ototoxicity, nephrotoxicit, and injection site rxn
39
what increases the risk of nephrotoxicity
when administered with other nephrotoxic drugs
40
What drug causes red man syndrome
Vancomycininfusion related reaction that is caused by the release of histamine.may cause erythematous or urticarial reactions, flushing tachycardia, hypotension
41
how do you manage red man syndrome?
stop infusion, wait for it to subside, then slow the infusion rate down no faster than 1gm/hr can also administer benadryl prior to infusion
42
what is the black box warning with Telavancin
warning in pre pregnancy which may cause abnormal fetal development. Perform pregnancy test in women of child bearing age
43
what type of infections are Telavacin used for
complicated skin and soft tissue infections. investigated for nosocomial pneumonianeeds to be dose adjust for renal function
44
what are the ADRS for Telavacin
Red man syndrome, infuse over 60min, nephrotoxicity, GI upset, metallic taste
45
What spectrum of activity does Daptomycin have
similar to vancomycin but it also covers vancomycin resistant enterococci vancomycin resistant s. aureus (VRSA)
46
What conditions is daptomycin used to treat
skin/soft tissue, bacteremia, endocarditis
47
what are adverse effects of daptomycin
injection site reaction, fever, chills, diarrhea, N/Vmuscle cramps/ weaknessmust monitor CPK and discontinue drug if muscle pain and elevation of CPK>5x ULN
48
What is Fosfomycin used to treat
oral formulation covers Gam (+),(-)used for UTI in women
49
what is bacitracin used for
used topically only very nephrotoxic
50
what is cycloserin used forwhat are its ADR?
covers gram (+), (-)mainly used to treat TBH/A, Tremors, acute psychosis
51
what is the MOA for tetracyclines
binds to the 30s ribosomal subunit which prevents binding of the tRNA to the mRNA ribosome complex which interferes with protein synthesis
52
what is the spectrum of activity for tetracycline?
S. pnemo, S. pyogenes, community acquired Staph (CA-MRSA)gram (-) ecoli, klebsiella, H influenzaeAtypical: C. pneumonae, M. neumoniae, legionella, C trachmatic, lyme
53
what are the clinical uses for tetracyclines
Respiratory infections, MRSA, CA-MRSAanthrax, chlamydia, lyme
54
what are adverse effects of tetracycline
GI intolerancePhotosensitivityTooth discoloration and abnormal bone growth (do not use in second half of pregnancy or kids younger than 8Vestibular tox.
55
What are the special considerations of tetracyclines
administration must be separated from food containing aluminum, magnesium, Calcium, and iron by 12 hoursFood: Minocycline: with or without foodTetracycline: empty stomachDoxycycline: with food due to GI intolerance
56
What does tigecycline cover
gram (+),(-) and anaerobes
57
what is the clinical uses of Tigecycline
used in complicated skin and skin structure inf. and complicated abdominal inf.CAPMRSAMRSEVREpenicillin resistant strep pneumo
58
what is the MOA for macrolides
bind to 50S ribosomal subunit, inhibiting bacterial protein synthesis
59
what drugs belong to macrolide class
FidaxomicinAzithromycinClarithromycinErythromycin
60
What is the spectrum of activity of Azithro, Clarithromycin, Erythromycin
Strep (+)H. inf, N gonnorrhoeae (-)Atypical: Myco, Legionella, Chlamydia
61
what is the spectrum of activity of Fidaxomicin
C. Diff
62
What are the common uses for Erythromycin, Calthromycin, Azithromycin
alternate for PCN allergyCAPPahryngitisOMAzithro- Urethritis
63
what are the ADR for macrolies Erythromycin, Azithro, Clarithromycin
N/VAbdominal paindiarrhearenal failureQT prolongation
64
what are the ADR for fidaxomicin
GI hemorrhageN/Vabdominal painAnemia neutropenia
65
What are the food interactions
Azithro and Erythro take one hour before or 2 hour after a meal
66
What are the drug interactions for Eryhtromycin and clarithromycin
inhibit CYP 450 enzyme
67
what are the drug interactions for azithro
may increase cyclosproine and digoxin levels
68
what is the MOA for clindaymycin
binds to 50s ribosome subunit and inhibits protein synthesis
69
what is the spectrum of activity for clindamycin
Stap. aureus, MSSA, CA-MRSA, Strep. ssp, peptostreptococusananerobes, C diff, prevotella, fusobacterium
70
what are the clinical uses for clindamycin
skin and soft tissue inf, CA-MRSA, anaerobes, aspiration PNA, dental prophylaxis in PCN pts
71
what are the adverse effects of Clindamycine
GI: diarrhea, nausea, dyspnearashHigh incidence of C diffheptao toxback pain
72
how should clindamycin be administered
with food to decrease GI upset and water to decrease esophageal ulceration
73
what is the spectrum of activity for linezolid
gram (+) onlyworks on staph(methacillin susceptible and resistant)works on staph(vancomycin intermed and resistant)Enterococcus faecium
74
what are the common uses for linezolid
MRSA, Vancomycin resistant E. faecium skin inf and soft tissuebone/ joint infbacteremia
75
what are some of the special considerations of linezolid
good pulm penetrationexhibits weak reversible inhibition of monoamine oxidaseoral form is 100% bioavailablepreferable in PVL and CA-MRSA
76
what drugs are part of the aminoglycosides
GentamicinTobreamycinAmikacinStreptomycinneomycinkenamycin
77
what is the MOA of aminoglycosides
inhibits 30s ribosomal subunit
78
what is the spectrum of activity of Gentamicin, tobramycin, amikacin
staph aureus, strep, enteroccmostly aerobic gram (-) bacilli
79
what is the clinical uses of gentamicin, tobramycin, amikacin
rarely used alone with gram (+) organisms, PNA, meningitisUsed with vancomycin or PCN for endocarditis
80
what are the ADR for aminoglycosides
ototoxicity, nephrotoxocity only occur when used longer than 5 days
81
what are the benefits of extended interval dosing
probable reduced nephrotoxicitydecreased lab monitoringno risk of sub-therapeutic peak leveldecreased pharmacy time for prepeasier for home care
82
what is the MOA of sulfonamides
competitive antagonist of para-aminobenzoic acid which prevents formation of folic acid
83
what is the spectrum of activity for sulfonamides
staph, s. pneumo, bacillus anthrasis, clostridium tetaniecoli, proteus mirabillis, H. influenzachlamydia trachomatis
84
what are the common uses of sulfonamides
UTI, toxoplasmosis1st line for MRSAURIHIV PNACA-MRSA
85
what are adverse reactions with sulfonamides
photosensitiviyrashSJSblood dyscrasiassulfa allergies
86
what drugs make up the fluroquinolones
CiprofloxacinOlfoxacinNorfloaxinLevofloxacinMoxifloxacin
87
what is the MOA of fluroquinolones
inhibit bacterial topoisomerase II
88
what is the spectrum of activity of cipro, ofloxacin, norfloxacin
enterobacteriacase, H. influ, M. catarrhalis, Neisseria,
89
what are the common uses of norfloxacin
uncomplicated UTI
90
what is cipro and ofloxacin
complicated UTI, gasteroenteritis, prostatits, STD, skin infCipro for anthrax prep
91
what is the spec of coverage withlevo, moxifloxacin, gatifloxacin
strep pneumo,enterobacteriacaseH.influenzaeM. catarrhalisNeisseria,
92
what is the clinical use of levofloxacin, moxifloxacin
CAP,URI infections
93
what are the adverse reactions of fluroquinolones
N/VDiarrhea,constipationtendon rupturephotosensitivityprolonged QT
94
what does metronidazole cover
protozaanaerobes bacteroidesFusobacteriumVeillonellaC. Diffpeptococcuspeptostreptococcus
95
what are the uses of metronidazole
intra abdominal infectionGyn infpseudomembraneous colitisC. diffH pylori
96
what are the adverse effects of metronidazole
dry mouth, metallic tasteanorexia abdominal painCNS
97
what is nitrofurantoin used to treat
UTI
98
what is nitrofurantoin spectrum of activity
e coli klebsiellastaphstrepViridiansenterococcus
99
what are some special considerations with nitrofurantoin
CrCl lass than 60mlHepatotoxicity and pulmonary toxicity probenecid may increase serum concentration
