Antibiotics Flashcards
1
Q
What are the 2 Natural Penicillins?
A
- ) Penicillin G (IV/IM)
2. ) Penicillin V (PO)
2
Q
What are the 3 kinds of Penicillinase Resistant Penicillins?
A
- ) Oxacilllin (IV)
- ) Nafcillin (IV)
- ) Dicloxacillion (PO on empty stomach)
3
Q
What are the 2 kinds of Aminopenicillins?
A
- ) Ampicillin (IV/IM/PO)
2. ) Amoxicillin (PO)
4
Q
What is the only Extended Spectrum Penicillin?
A
1.) Pipercillin (IV)
5
Q
What are the 3 kinds of B Lactam/B Lactamase Penicillins?
A
- ) Ampicillin/Sulbactam (Unasyn) IV
- ) Pipercillin/Tazobactam (Zosyn) IV
- ) Amoxicillin/Clavulanate (Augmentin) PO
6
Q
What antibiotics alter cell wall permeability?
A
- ) Beta Lactams
2. ) Glycopeptides
7
Q
What antibiotics interfere with DNA replication and transcription?
A
- ) Fluoroquinolones
2. ) Rifampin
8
Q
What antibiotics bind to the 30s/50s ribosomal subunit?
A
- ) Macrolids
- ) Aminoglycosides
- ) Ketolides
- ) Tetracyclines
- ) Oxazolidinones
- ) Streptogramins
9
Q
Name 5 classes of Broad spectrum drugs
A
- ) Amino PCN
- ) Extended spectrum PCN
- ) 3rd generation ceph
- ) 4th generation ceph
- ) carbapenems
10
Q
Vancomycin covers…
A
gram positives
11
Q
Metronidazole (Flagyl) covers…
A
anaerobes
12
Q
Aminoglycosides and Aztreonam cover…
A
gram negatives
13
Q
What are the 4 factors of Pharmokinetics?
A
- ) Bioavailability
- ) Distribution
- ) Metabolism
- ) Elimination
14
Q
What are 3 reasons why you wouldn’t test the MIC for a clinical specimen?
A
- ) susceptibility pattern of an isolate is predictable based on genus and species
- ) the organism is likely part of the normal flora
- ) there are in insufficient number of colonies present
15
Q
What drugs have a long post antibiotic effect against GNR’s?
A
- ) Macrolides
- ) Aminoglycosides
- ) Quinolones
16
Q
Maximal concentration is the goal of therapy for what drugs?
A
- ) Fluoroquinolones
- ) Aminoglycosides
- ) Daptomycin
- ) Ketolides
17
Q
Maximal duration of exposure if the goal of therapy for what drugs?
A
- ) Carbapenems
- ) Cephalosporins
- ) Penicillins
- ) Erythromycin
18
Q
Maximal amount of drug is the goal of therapy for what drugs? (Maggie licks the vanilla cone)
A
- ) Macrolides
- ) Linezolid
- ) Tetracycline
- ) Vancomycin
- ) Clindamycin
19
Q
What are the 4 mechanisms of primary drug resistance?
A
- ) alter outer membrane permeability
- ) alter drug binding sites
- ) enzyme production for drug inactivation
- ) efflux of abx from the bacteria
20
Q
What are examples of some bactericidal drugs?
A
Beta Lactams, Cephalosporins (only when actively multiplying), Quinolones, Aminoglycosides
21
Q
What are examples of some bacteriostatic drugs?
A
clindamycin, macrolides, sulfonamides, tetracyclines
22
Q
True or False- Bacteriostatic drugs can be -cidal at high concentrations?
A
true
23
Q
accumulation of aminoglycosides in what kind of tissue can lead to toxicity?
A
renal tissue, leads to nephrotoxicity
24
Q
What drugs DON’T cross the BBB?
A
- ) aminoglycosides
- ) clindamycin
- ) 1st gen cephs
- ) 2nd gen cephs
not with AC on setting 1/2
25
What tissues are difficult to penetrate with an antibiotic?
```
prostate
bone
synovial fluid
peritoneal fluid
abscess
```
26
Spectrum for Natural PCNs (Pen G and Pen V)
Actinomyces, meningiococcus, Pastruella, Strep. pneumo, Strep. pyrogens, T. pallidum
27
Spectrum for Penicillinase Resistant PCNs
S. aureus (not MRSA)
28
Spectrum for Aminopenicillins
most enterococci, E. coli, H. influenza, Proteus, Klebsiella
*great on GRN's
29
Spectrum for Extended Spectrum PCNs
similar to aminopenicillins, increased spectrum for anaerobes, pseudomonas
30
Ampicillin and Sulbactam
Unasyn (IV)
31
Pipercillin and Tazobactam
Zosyn (IV)
32
Amoxicillin and Clavulanate
Augmentin (PO)
33
What drug is often added to Pipercillin?
Tazobactam
34
What BLactam/BLactamase Inhibitor causes diarrhea?
Augmentin (specifically the Clavulanate portion)
35
What bugs do Cephalosporins NOT have activity against?
- MRSA
- MRSE
- PRSP
- enterococci
- Legionella
*DO NOT TREAT ATYPICAL PNEUMONIA WITH A CEPHALOSPORIN!
36
What Pregnancy category are all Cephalosporins?
B
37
Spectrum for 1st generation Cephalosporins
S. aureus (not MRSA)
-best Cephalosporin for Gram Positives
38
Spectrum for 2nd generation Cephalosporins
Cefotan- abdominal infections, bowel surgery prophylasix, OBGYN infections
Ceftin- Upper and Lower RTI's, OM, COPD exacerbations, sinusitis
39
Spectrum for 3rd generation Cephalosporins
ceftriaxone (Rocephin)- severe gram (-) infections, meningitis with high dose, pneumonia (w/ macrolide)
ceftazadime (Fortaz)- Pseudomonas
cefpodoxime (Vantin) and cefixime (Suprax)- UTI's and RTI's
40
Spectrum for 4th generation Cephalosporins
cefepime- Pseudomonas, GRN's resistant to ceftaz, ceftriaxone, aztreonam
41
Spectrum for 5th generation Cephalosporins
ceftaroline- similar to ceftriaxone but with enhanced gram (+) coverage, with MRSA coverage
42
When should 1st generation cephalosporins be used?
SSSI's
surgical prophylaxis
UTI's
43
What cephalosporin causes biliary sludging?
ceftriaxone (Rocephin)
- no need to adjust for decreased GFR
- used for severe gram negative infections, meningitis in high doses and pneumonia when used with a macrolide
44
When should cefepime, a 4th generation be used?
- febrile neutropenia
- HAP
- other serious gram negative infections
45
imipenem/ciliastatin (Primaxin) IV
- broad spectrum, including MSSA
- pregnancy category C
- use for Pseudomonas or serious polymicrobial infection
- seizure risk
46
meropenem (IV)
- similar to imipenem
- less risk for seizure, less Staph./Strep. activity
- pregnancy category B
47
ertapenem (IV)
- doesn't cover Pseudomonas
| - used for abdominal infections
48
What 3 drugs are Carbapenems?
1. ) imipenem/ciliastatin (Primaxin)
2. ) merepenem
3. ) ertapenem
49
aztreonam (Azactam) IV
- gram negative ONLY, and Pseudomonas
- pregnancy category B
- well tolerated
- considered safe even in PCN allergy
50
what are the 3 IV Aminoglycosides?
1. ) Tobramycin
2. ) Amikacin
3. ) Gentomycin
(streptomycin and neomycin are rarely used)
51
Aminoglycosides
- inhibit 30s/50s ribosome
- long PAE
- bacteriocidal
- good gram negative activity and Pseudomonas
- very poor absorption
- Pregnancy category D
52
When are aminoglycosides used?
- serious gram negative infections, often with 2nd agent
| - in combination with B lactam for synergy
53
What are 2 adverse drug reactions for aminoglycosides?
- nephrotoxicity (6-25%) REVERSIBLE
| - ototoxicity (25%) IRREVERSIBLE
54
What are 3 kinds of macrolides?
1. ) Azithromycin (Zithromax) IV/PO
2. ) Erythromycin IV/PO
3. ) Clathromycin PO
55
Macrolides
- inhibit protein synthesis
- bacteriostatic, can be -cidal at high doses
- covers pneumococcals and atypicals
-ADR's include GI upset (take with food), QT prolongation, and many drug interactions
56
What is the pregnancy classification for macrolides?
Azithromycin (Zithromax) and Erythromycin = B
Clindamycin (Biaxin) = C
57
What are the uses for macrolides?
- otitis media
- community acquired pneumonia
- COPD exacerbation
- STD's (azithromycin)
58
Clathromycin
- good for erythromycin sensitive strains of enterococci
| - only modest activity against H. influenzae
59
Azithromycin
- more active against H. influenzae
- very active against Chlamydia
- half life of 68 hours
60
What are the 5 kinds of Fluoroquinolones?
1. ) ofloxacin
2. ) ciprofloxacin (Cipro)
3. ) levofloxacin (Levaquin)
4. ) moxifloxacin (Avelox)
5. ) gemifloxacin (Factive)
61
Fluoroquinolones
- inhibits DNA replication and transcription
- covers Legionella
- well absorbed orally
- widely distributed
- pregnancy category C
- contraindicated in patients under 18 (arthropathy)
62
What fluoroquinolones cover Pseudomonas?
- Ciprofloxacin (Cipro)
| - Levofloxacin (Levo)
63
What is the spectrum for fluoroquinolones?
- gram negative coverage good but increased resistance lately
- newer agents better on gram positives, minimal anaerobic coverage
- avoid using for S. aureus
64
What is the only fluoroquinolone that doesn't need to be adjusted for a decreased GFR?
moxifloxacin (Avelox)
*only one without a drug interaction with sulcralfate
65
What are the adverse drug reactions for fluoroquinolones?
- N/V/D
- HA
- restlessness
- tendon rupture
- elevated AST/ALT
- peripheral neuropathy
66
What are the uses for fluoroquinolones?
- community acquired pneumonia
- UTI's
- COPD exacerbation
- sinusitis
- AECB
- serious gram negative infections
67
What are the 3 kinds of Tetracyclines?
1. ) Tetracycline
2. ) Monocycline
3. ) Doxycycline
68
Tetracyclines
- inhibit protein synthesis
- pregnancy category D
- contraindicated for those under 8 (inhibits bone growth and permanent discoloration of teeth)
- increased affect of warfarin
- may cause necrosis of liver (very rare)
69
What is the spectrum for tetracycline use?
- broad spectrum use of GP's and GN's
| - rickettsia, Chlamydia, Mycoplasma
70
What are tetracyclines used to treat?
- community acquired pneumonia
- Chlamydia
- syphillis in PCN allergic patients
- Lyme Disease
- acne
- community acquired MRSA
71
What are the adverse drug reactions for tetracyclines?
- GI upset
- photosensitivity
- erosive esophagitis (Doxycycline)
- vestibular symptoms (Minocycline)
72
When do you need to dose adjust tetracyclines?
when the CrCl is less than 10
73
Vancomycin
- IV and oral (only for C. diff)
- inhibits cell wall synthesis
- considered a -cidal drug
- Pregnancy category C
- penetrates the CSF
- avoid indiscriminant use
74
What is the spectrum for Vancomycin?
- gram positives, including MRSA and MRSE
| - moderate anaerobic coverage
75
What are the adverse drug reactions associated with Vancomycin?
Redman's Syndrome- rash on face/chest, flushing, hypotension
* infuse over 1 hour to prevent Redmans
- also causes reversible neutropenia
76
clindamycin (Cleocin)
- IV, PO, topical (acne), vaginal
| - inhibits protein synthesis
77
What is the spectrum for clindamycin?
- Staph (MRSA too)
- Strep
- anaerobes
78
When should clindamycin be used?
- an anaerobic abscess
- abdominal infection
- GYN infection
79
Metronidazole (Flagyl)
- IV, PO, vaginal
- inhibits DNA synthesis
- pregnancy category B (avoid in 1st trimester)
- spectrum: anaerobic and amecidie
- penetrates the CSF
80
When should you use Flagyl?
- abdominal abscesses
- C. difficile colitis
- H. pylori
81
Flagyl has a reaction with...
alcohol (ETOH)
82
TMP/SMZ
- trimethoprim/sulfamethoaxazole (sulfa/bactrim)
- IV, PO (95% of time given orally)
- inhibits folic acid synthesis (-static)
- Pregnancy Class C, (D at term)
- hepatic metabolism
- renal elimination
83
When is TMP/SMZ contraindicated?
-in the 3rd trimester with less than 2 weeks remaining
84
What is the spectrum for TMP/SMZ?
- more than 90% sensitive for Staph infections
- Strep
- many GRNs
- Pneumocystitis
85
TMP/SMZ is the mainstay for the treatment of what?
- uncomplicated UTIs
| - DOC for pneumocystitis
86
Who needs to have their kidney function monitored while on TMP/SMZ?
- patient with underlying renal insufficiency
| - prolonged therapy patients
87
TMP/SMZ increases the effect of...
- warfarin
- oral hypoglycemics
- phenytoin
- methotrexate
- cyclosporin
88
What are the adverse drug reactions for TMP/SMZ?
- 10% get a rash
- photosensitivity
- CNS disturbances
- GI symptoms
89
Rifampin
- PO
- inhibits bacterial RNA synthesis
- need to monitor LFT's (can be hepatotoxic)
- potent cytochrome P450 inhibitor (call pharmacist)
90
What is Rifampin used for?
- TB
- meningococcal prophylaxis
- nasal carriers or MRSA
- synergy for certain S. aureus infections (osteo)
91
Does Rifampin cover MRSA?
YES, but CAN'T be used alone as it will rapidly develop resistance
92
What are the adverse drug reactions for Rifampin?
- GI upset
- rash
- turns secretions red/orange/brown (urine, sweat, tears, contacts)
93
Linezolid (Zyvox)
- IV, PO (100% bioavailable)
- oxazolinidone class
- for MRSA and VRE infections
- more support for use in serious MRSA infections
94
What are the adverse drug reactions for Linezolid?
- reversible thrombocytopenia
| - anemia
95
What is the spectrum of use for Linezolid?
- Staph infections (MRSA)
- Coag (-) Staph
- Strep
- VRE
- some anaerobes
96
daptomycin (Cubicin)
- IV only
- covers MRSA, VRSA, VRE
- used for complicated skin and soft tissue infection
- good alternative for resistant pathogens
97
tegecyline (Tygacil)
- IV only (tetracycline derivative)
- covers MRSA, VRE, Strep, enteric GRN's, bowel anaerobes
- newer drug that is being utilized more and more
98
What are the 4 kinds of Semisynthetic Glycopeptides?
- all IV only
- SSSI due to gram (+) organisms, including MRSA
1. ) Dalbavanacin
2. ) Oritavancin
3. ) Telavancin
99
Dalbavanacin
- half life of 6-12 days
| - once weekly dosing
100
Oritavancin
- half life around 100 hours
- once weekly dosing
- covers VRE
101
Telavancin
- half life of 7-9 hours
- once daily dosing
- indicated for MRSA pneumonia and covers VISA and VRSA
102
quinupristin/dalfopristin (Synercid)
- Streptogramin class
- IV only in central line
- very rarely used
103
What are the adverse drug reactions for Synercid?
- myalgias
| - arthralgias
104
What is the spectrum for Synercid?
- MRSA
| - VRE
105
Mupirocin (Bactroban)
- topical antibiotic
- can be used for nasal carriage of S. aureus, especially MRSA
- used to treat impetigo due to S. aureus, S. pyrogenes, and other Beta strep
106
nitrofurantoin (Macrodantin)
- used for Gram Positives, enterococci, E. coli
- Pregnancy category B
- less absorption when taken with antacids
- mainly prescribed by urologists
107
What are the adverse drug reactions for nitrofurantoin?
- nausea
- vomitting
- diarrhea
- turns urine brown
* TAKE WITH FOOD!
108
What are the warnings and precautions for nitrofurantoin (Macrodantin)?
- G6PD deficiency
| - can cause interstitial pulmonary fibrosis with chronic use
109
fidaxomicin (Dificid)
- oral
- absorbed in GI tract and excreted in the feces
- abdominal pain is main SE
- very costly!
110
When is fidazomicin (Dificid) taken?
-for C. diff or associated diarrhea (CDAD)
