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First Aid Step 1 material > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Penicillin G, V Mechanism

A 
β-lactam antibiotics
Bind PBP (transpeptidases).
Block transpeptidase cross-linking of peptidoglycan in cell wall. 
Activate autolytic enzymes.
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2
Q

Penicillin G, V clinical use

A

Strep and gonorrhea

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3
Q

Penicillin G, V Toxicity

A

Hypersensitivity reactions, hemolytic anemia.

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4
Q

Amoxicillin, ampicillin (aminopenicillins) clinical use HHELPSS

A

H. influenzae, H. pylori, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, Shigella, enterococci.

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5
Q

Amoxicillin, ampicillin (aminopenicillins) toxicity

A

Hypersensitivity reactions; diarrhea

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6
Q

Dicloxacillin, nafcillin, oxacillin (penicillinase-resistant) clinical use

A

Strep and Staph (except MRSA)

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7
Q

Dicloxacillin, nafcillin, oxacillin (penicillinase-resistant) toxicity

A

Hypersensitivity reactions, interstitial nephritis.

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8
Q

Piperacillin, ticarcillin clinical use

A

only PCN for PSEUDOMONAS
Strep
SPACE
PEcK

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9
Q

Piperacillin, ticarcillin toxicity

A

Hypersensitivity reactions.
Ticarcillin Na+ overload
dose dependent platelet dysfunction

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10
Q

β-lactamase inhibitors CAST mnemonic

A

Clavulanic Acid, Sulbactam, Tazobactam.

Often added to penicillin antibiotics to protect the antibiotic from destruction by β-lactamase

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11
Q

Cephalosporins (generations I–V) Mechanism

A

β-lactam drugs that inhibit peptidoglycan cross-linking

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12
Q

Organisms typically not covered by cephalosporins are LAME and the exception

A

Listeria, Atypicals (Chlamydia, Mycoplasma, Legionella), MRSA, and Enterococci.

Exception: ceftaroline covers MRSA and enterocci

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13
Q

1st generation Cephalosporin (cefazolin, cephalexin) clinical use (PEcK mnemonic)

A

staph, strep

Proteus mirabilis, E. coli, Klebsiella pneumoniae.

Cefazolin used prior to surgery to prevent S. aureus wound infections.

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14
Q

2nd generation Cephalosporin (cefoxitin, cefotetan, cefuroxime) (HEN PEcKS mnemonic)

A

staph, strep

H. influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. coli, Kleb. pneumoniae, Serratia marcescens.

TANFOX - anaerobes

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15
Q

3rd generation Cephalosporin (ceftriaxone, ceftazidime) clinical use

A

serious gram-negative infections, S(P)ACE

community acquired and nosocomial pneumonia

Meningitis

Ceftriaxone—meningitis, gonorrhea
Ceftazidime—Pseudomonas

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16
Q

4th generation Cephalosporin (cefepime)

A

staph, strep
SPACE
fever in neutropenia

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17
Q

5th generation Cephalosporin (ceftaroline)

A

staph, strep,
MRSA
enterococcus

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18
Q

Cephalosporin toxicity

A

Hypersensitivity reactions, autoimmune hemolytic anemia, disulfiram-like reaction, vitamin K deficiency. Exhibit cross-reactivity with penicillins.􏰃nephrotoxicity of aminoglycosides.

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19
Q

Carbapenems (Imipenem, meropenem, ertapenem, doripenem) mechanism

A

Binds to PBP-1 and PBP-2, B-Lactamase resistant

Always administered with cilastatin (inhibitor of renal dehydropeptidase I) to􏰄 decrease inactivation of drug in renal tubules.

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20
Q

Imipenem mnemonic

A

With imipenem, “the kill is lastin’ with cilastatin.”

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21
Q

Carbapenem (Imipenem, meropenem, ertapenem, doripenem) clinical use

A

Gram-positive cocci, gram-negative rods, and anaerobes.

significant side effects limit use to life-threatening infections or after other drugs have failed.

Meropenem has a decreased 􏰄risk of seizures and is stable to dehydropeptidase I.

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22
Q

Carbapenem (Imipenem, meropenem, ertapenem, doripenem) toxicity

A

GI distress, skin rash, and CNS toxicity (SEIZURES)

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23
Q

Vancomycin Mechanism

A

Inhibits cell wall peptidoglycan formation by binding D-ala D-ala portion of cell wall precursors.

Bactericidal.

Not susceptible to β-lactamases.

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24
Q

Vancomycin clinical use

A

Gram-positive bugs only—serious, multidrug-resistant organisms.

Clostridium difficile (oral dose for pseudomembranous colitis).

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25
Vancomycin Toxicity (NOT mnemonic)
Nephrotoxicity, Ototoxicity, Thrombophlebitis Red Man Syndrome (can largely prevent by pretreatment with antihistamines and slow infusion rate).
26
Aminoglycosides (Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin) mechanism
Bactericidal; irreversible inhibition of initiation complex through binding of the 30S subunit. Messes with LPS Require O2 for uptake; therefore ineffective against anaerobes.
27
Aminoglycosides (Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin) clinical use
Severe gram-negative infections. Neomycin for bowel surgery.
28
Aminoglycosides (Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin) toxicity
Nephrotoxicity, Neuromuscular blockade, Ototoxicity, Teratogen.
29
Aminoglycosides mnemonic
GNATS caNNOT kill anaerobes.
30
Tetracyclines (Tetracycline, doxycycline, minocycline) Mechanism
Bacteriostatic; bind to 30S, limited CNS penetration. Doxycycline is fecally eliminated and can be used in patients with renal failure. Do not take tetracyclines with milk, antacids or iron-containing preparations because divalent cations inhibit drugs’ absorption in the gut.
31
Tetracyclines (Tetracycline, doxycycline, minocycline) Clinical Use
Lyme Disease, M. pneumoniae, Rickettsia, Chlamydia, acne, vibrio cholera, brucellosis (unpasteurized cheese and milk) demeclocycline used to treat SIADH
32
Tetracyclines (Tetracycline, doxycycline, minocycline) Toxicity
GI distress, discoloration of teeth and inhibition of bone growth in children, photosensitivity. Fanconi-like syndrome - urine problems Contraindicated in pregnancy.
33
Chloramphenicol mechanism
Blocks peptidyltransferase at 50S ribosomal subunit. Bacteriostatic.
34
Chloramphenicol clinical use
Meningitis and Rocky Mountain spotted fever (Rickettsia rickettsii)
35
Chloramphenicol toxicity
Anemia (dose dependent), aplastic anemia (dose independent), gray baby syndrome (in premature infants because they lack liver UDP-glucuronyl transferase).
36
Clindamycin mechanism
Blocks peptide transfer (translocation) at 50S ribosomal subunit. Bacteriostatic.
37
Clindamycin clinical use
Anaerobic infections in aspiration pneumonia, lung abscesses, and oral infections. Also effective against invasive group A strep
38
Clindamycin use vs Metronidazole use
Treats anaerobic infections above the diaphragm vs. metronidazole (anaerobic infections below diaphragm).
39
Clindamycin toxicity
Pseudomembranous colitis (C. difficile overgrowth), fever, diarrhea.
40
Oxazolidinones (Linezolid) mechanism
Inhibit protein synthesis by binding to 50S subunit and preventing formation of the initiation complex.
41
Oxazolidinones (Linezolid) clinical use
Gram-positive species including MRSA and VRE
42
Oxazolidinones (Linezolid) toxicity
Bone marrow suppression (especially thrombocytopenia), peripheral neuropathy, serotonin syndrome.
43
Monobactams (Aztreonam) mechanism
Less susceptible to β-lactamases. Prevents peptidoglycan cross-linking by binding to PBP-3. Synergistic with aminoglycosides. No cross-allergenicity with penicillins.
44
Monobactams (Aztreonam) clinical use
Gram-negative rods only For penicillin-allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides.
45
Monobactams (Aztreonam) toxicity
Usually nontoxic; occasional GI upset.
46
Macrolides (Azithromycin, clarithromycin, erythromycin) mechanism
Inhibit protein synthesis by blocking translocation (“macroslides”); bind to the 23S rRNA of the 50S ribosomal subunit. Bacteriostatic.
47
Macrolides (Azithromycin, clarithromycin, erythromycin) clinical use
Atypicals Atypical pneumonias (Mycoplasma, Chlamydia, Legionella), STIs (Chlamydia), gram-positive cocci (streptococcal infections in patients allergic to penicillin), and B. pertussis.
48
Macrolides (Azithromycin, clarithromycin, erythromycin) toxicity (MACRO mnemonic)
MACRO: Gastrointestinal Motility issues, Arrhythmia caused by prolonged QT interval, acute Cholestatic hepatitis, Rash, eOsinophilia. Increases serum concentration of theophyllines, oral anticoagulants. Clarithromycin and erythromycin inhibit cytochrome P-450.
49
Trimethoprim mechanism
Inhibits bacterial dihydrofolate reductase. block of folate synthesis. Bacteriostatic.
50
Trimethoprim clinical use
Used in combination with sulfonamides (TMP- SMX) Combination used for UTIs, Shigella, Salmonella, Pneumocystis jirovecii pneumonia treatment and prophylaxis, toxoplasmosis prophylaxis.
51
Trimethoprim toxicity (TMP mnemonic)
Megaloblastic anemia, leukopenia, granulocytopenia. (May alleviate with supplemental folinic acid). TMP Treats Marrow Poorly.
52
Sulfonamides (Sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine) mechanism
Inhibit folate synthesis. Para-aminobenzoic acid (PABA) antimetabolites inhibit dihydropteroate synthase. Bacteriostatic (bactericidal when combined with trimethoprim). Dapsone, used to treat lepromatous leprosy, is a closely related drug that also inhibits folate synthesis.
53
Sulfonamides (Sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine) clinical use
Gram-positives, gram-negatives, Nocardia, Chlamydia. Triple sulfas or SMX for simple UTI.
54
Sulfonamides (Sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine) toxicity
Hypersensitivity reactions, hemolysis if G6PD deficient, nephrotoxicity (tubulointerstitial nephritis), photosensitivity, kernicterus in infants displace other drugs from albumin (e.g., warfarin).
55
Fluoroquinolones (Ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, moxifloxacin, gemifloxacin, enoxacin) mechanism
Inhibit prokaryotic enzymes topoisomerase II (DNA gyrase) and topoisomerase IV. Bactericidal. Must not be taken with antacids.
56
Fluoroquinolones (Ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, moxifloxacin, gemifloxacin, enoxacin) clinical use
Gram-negative rods of urinary and GI tracts (including Pseudomonas), Neisseria, some gram-positive organisms.
57
Fluoroquinolones (Ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, moxifloxacin, gemifloxacin, enoxacin) toxicity
GI upset, superinfections, skin rashes, headache, dizziness. Less commonly, can cause leg cramps and myalgias. Contraindicated in pregnant women, nursing mothers, and children 60 years old and in patients taking prednisone.
58
Fluroquinolones toxicity mnemonic
Fluoroquinolones hurt attachments to your bones.
59
Daptomycin mechanism
Lipopeptide that disrupts cell membrane of gram-positive cocci.
60
Daptomycin clinical use
S. aureus skin infections (especially MRSA), bacteremia, endocarditis, VRE. Not used for pneumonia (avidly binds to and is inactivated by surfactant).
61
Daptomycin toxicity
Myopathy, rhabdomyolysis.
62
Metronidazole mechanism
Forms toxic free radical metabolites in the bacterial cell that damage DNA. Bactericidal, antiprotozoal.
63
Metronidazole clinical use (GET GAP on the Metro with metronidazole!)
Treats Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes (Bacteroides, C. difficile). Used with a proton pump inhibitor and clarithromycin for “triple therapy” against H. Pylori.
64
Metronidazole toxicity
Disulfiram-like reaction with alcohol; headache, metallic taste.

First Aid Step 1 material (10 decks)

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