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Pharm II > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

What are the 2 Natural Penicillins?

A
  1. ) Penicillin G (IV/IM)

2. ) Penicillin V (PO)

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2
Q

What are the 3 kinds of Penicillinase Resistant Penicillins?

A
  1. ) Oxacilllin (IV)
  2. ) Nafcillin (IV)
  3. ) Dicloxacillion (PO on empty stomach)
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3
Q

What are the 2 kinds of Aminopenicillins?

A
  1. ) Ampicillin (IV/IM/PO)

2. ) Amoxicillin (PO)

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4
Q

What is the only Extended Spectrum Penicillin?

A

1.) Pipercillin (IV)

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5
Q

What are the 3 kinds of B Lactam/B Lactamase Penicillins?

A
  1. ) Ampicillin/Sulbactam (Unasyn) IV
  2. ) Pipercillin/Tazobactam (Zosyn) IV
  3. ) Amoxicillin/Clavulanate (Augmentin) PO
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6
Q

What antibiotics alter cell wall permeability?

A
  1. ) Beta Lactams

2. ) Glycopeptides

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7
Q

What antibiotics interfere with DNA replication and transcription?

A
  1. ) Fluoroquinolones

2. ) Rifampin

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8
Q

What antibiotics bind to the 30s/50s ribosomal subunit?

A
  1. ) Macrolids
  2. ) Aminoglycosides
  3. ) Ketolides
  4. ) Tetracyclines
  5. ) Oxazolidinones
  6. ) Streptogramins
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9
Q

Name 5 classes of Broad spectrum drugs

A
  1. ) Amino PCN
  2. ) Extended spectrum PCN
  3. ) 3rd generation ceph
  4. ) 4th generation ceph
  5. ) carbapenems
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10
Q

Vancomycin covers…

A

gram positives

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11
Q

Metronidazole (Flagyl) covers…

A

anaerobes

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12
Q

Aminoglycosides and Aztreonam cover…

A

gram negatives

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13
Q

What are the 4 factors of Pharmokinetics?

A
  1. ) Bioavailability
  2. ) Distribution
  3. ) Metabolism
  4. ) Elimination
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14
Q

What are 3 reasons why you wouldn’t test the MIC for a clinical specimen?

A
  1. ) susceptibility pattern of an isolate is predictable based on genus and species
  2. ) the organism is likely part of the normal flora
  3. ) there are in insufficient number of colonies present
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15
Q

What drugs have a long post antibiotic effect against GNR’s?

A
  1. ) Macrolides
  2. ) Aminoglycosides
  3. ) Quinolones
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16
Q

Maximal concentration is the goal of therapy for what drugs?

A
  1. ) Fluoroquinolones
  2. ) Aminoglycosides
  3. ) Daptomycin
  4. ) Ketolides
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17
Q

Maximal duration of exposure if the goal of therapy for what drugs?

A
  1. ) Carbapenems
  2. ) Cephalosporins
  3. ) Penicillins
  4. ) Erythromycin
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18
Q

Maximal amount of drug is the goal of therapy for what drugs? (Maggie licks the vanilla cone)

A
  1. ) Macrolides
  2. ) Linezolid
  3. ) Tetracycline
  4. ) Vancomycin
  5. ) Clindamycin
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19
Q

What are the 4 mechanisms of primary drug resistance?

A
  1. ) alter outer membrane permeability
  2. ) alter drug binding sites
  3. ) enzyme production for drug inactivation
  4. ) efflux of abx from the bacteria
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20
Q

What are examples of some bactericidal drugs?

A

Beta Lactams, Cephalosporins (only when actively multiplying), Quinolones, Aminoglycosides

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21
Q

What are examples of some bacteriostatic drugs?

A

clindamycin, macrolides, sulfonamides, tetracyclines

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22
Q

True or False- Bacteriostatic drugs can be -cidal at high concentrations?

A

true

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23
Q

accumulation of aminoglycosides in what kind of tissue can lead to toxicity?

A

renal tissue, leads to nephrotoxicity

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24
Q

What drugs DON’T cross the BBB?

A
  1. ) aminoglycosides
  2. ) clindamycin
  3. ) 1st gen cephs
  4. ) 2nd gen cephs

not with AC on setting 1/2

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25
Q

What tissues are difficult to penetrate with an antibiotic?

A 
prostate
bone
synovial fluid
peritoneal fluid
abscess
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26
Q

Spectrum for Natural PCNs (Pen G and Pen V)

A

Actinomyces, meningiococcus, Pastruella, Strep. pneumo, Strep. pyrogens, T. pallidum

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27
Q

Spectrum for Penicillinase Resistant PCNs

A

S. aureus (not MRSA)

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28
Q

Spectrum for Aminopenicillins

A

most enterococci, E. coli, H. influenza, Proteus, Klebsiella

*great on GRN’s

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29
Q

Spectrum for Extended Spectrum PCNs

A

similar to aminopenicillins, increased spectrum for anaerobes, pseudomonas

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30
Q

Ampicillin and Sulbactam

A

Unasyn (IV)

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31
Q

Pipercillin and Tazobactam

A

Zosyn (IV)

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32
Q

Amoxicillin and Clavulanate

A

Augmentin (PO)

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33
Q

What drug is often added to Pipercillin?

A

Tazobactam

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34
Q

What BLactam/BLactamase Inhibitor causes diarrhea?

A

Augmentin (specifically the Clavulanate portion)

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35
Q

What bugs do Cephalosporins NOT have activity against?

A
  • MRSA
  • MRSE
  • PRSP
  • enterococci
  • Legionella

*DO NOT TREAT ATYPICAL PNEUMONIA WITH A CEPHALOSPORIN!

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36
Q

What Pregnancy category are all Cephalosporins?

A

B

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37
Q

Spectrum for 1st generation Cephalosporins

A

S. aureus (not MRSA)

-best Cephalosporin for Gram Positives

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38
Q

Spectrum for 2nd generation Cephalosporins

A

Cefotan- abdominal infections, bowel surgery prophylasix, OBGYN infections

Ceftin- Upper and Lower RTI’s, OM, COPD exacerbations, sinusitis

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39
Q

Spectrum for 3rd generation Cephalosporins

A

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

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40
Q

Spectrum for 4th generation Cephalosporins

A

cefepime- Pseudomonas, GRN’s resistant to ceftaz, ceftriaxone, aztreonam

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41
Q

Spectrum for 5th generation Cephalosporins

A

ceftaroline- similar to ceftriaxone but with enhanced gram (+) coverage, with MRSA coverage

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42
Q

When should 1st generation cephalosporins be used?

A

SSSI’s
surgical prophylaxis
UTI’s

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43
Q

What cephalosporin causes biliary sludging?

A

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
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44
Q

When should cefepime, a 4th generation be used?

A
  • febrile neutropenia
  • HAP
  • other serious gram negative infections
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45
Q

imipenem/ciliastatin (Primaxin) IV

A
  • broad spectrum, including MSSA
  • pregnancy category C
  • use for Pseudomonas or serious polymicrobial infection
  • seizure risk
46
Q

meropenem (IV)

A
  • similar to imipenem
  • less risk for seizure, less Staph./Strep. activity
  • pregnancy category B
47
Q

ertapenem (IV)

A
  • doesn’t cover Pseudomonas

- used for abdominal infections

48
Q

What 3 drugs are Carbapenems?

A
  1. ) imipenem/ciliastatin (Primaxin)
  2. ) merepenem
  3. ) ertapenem
49
Q

aztreonam (Azactam) IV

A
  • gram negative ONLY, and Pseudomonas
  • pregnancy category B
  • well tolerated
  • considered safe even in PCN allergy
50
Q

what are the 3 IV Aminoglycosides?

A
  1. ) Tobramycin
  2. ) Amikacin
  3. ) Gentomycin

(streptomycin and neomycin are rarely used)

51
Q

Aminoglycosides

A
  • inhibit 30s/50s ribosome
  • long PAE
  • bacteriocidal
  • good gram negative activity and Pseudomonas
  • very poor absorption
  • Pregnancy category D
52
Q

When are aminoglycosides used?

A
  • serious gram negative infections, often with 2nd agent

- in combination with B lactam for synergy

53
Q

What are 2 adverse drug reactions for aminoglycosides?

A
  • nephrotoxicity (6-25%) REVERSIBLE

- ototoxicity (25%) IRREVERSIBLE

54
Q

What are 3 kinds of macrolides?

A
  1. ) Azithromycin (Zithromax) IV/PO
  2. ) Erythromycin IV/PO
  3. ) Clathromycin PO
55
Q

Macrolides

A
  • 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
Q

What is the pregnancy classification for macrolides?

A

Azithromycin (Zithromax) and Erythromycin = B

Clindamycin (Biaxin) = C

57
Q

What are the uses for macrolides?

A
  • otitis media
  • community acquired pneumonia
  • COPD exacerbation
  • STD’s (azithromycin)
58
Q

Clathromycin

A
  • good for erythromycin sensitive strains of enterococci

- only modest activity against H. influenzae

59
Q

Azithromycin

A
  • more active against H. influenzae
  • very active against Chlamydia
  • half life of 68 hours
60
Q

What are the 5 kinds of Fluoroquinolones?

A
  1. ) ofloxacin
  2. ) ciprofloxacin (Cipro)
  3. ) levofloxacin (Levaquin)
  4. ) moxifloxacin (Avelox)
  5. ) gemifloxacin (Factive)
61
Q

Fluoroquinolones

A
  • inhibits DNA replication and transcription
  • covers Legionella
  • well absorbed orally
  • widely distributed
  • pregnancy category C
  • contraindicated in patients under 18 (arthropathy)
62
Q

What fluoroquinolones cover Pseudomonas?

A
  • Ciprofloxacin (Cipro)

- Levofloxacin (Levo)

63
Q

What is the spectrum for fluoroquinolones?

A
  • gram negative coverage good but increased resistance lately
  • newer agents better on gram positives, minimal anaerobic coverage
  • avoid using for S. aureus
64
Q

What is the only fluoroquinolone that doesn’t need to be adjusted for a decreased GFR?

A

moxifloxacin (Avelox)

*only one without a drug interaction with sulcralfate

65
Q

What are the adverse drug reactions for fluoroquinolones?

A
  • N/V/D
  • HA
  • restlessness
  • tendon rupture
  • elevated AST/ALT
  • peripheral neuropathy
66
Q

What are the uses for fluoroquinolones?

A
  • community acquired pneumonia
  • UTI’s
  • COPD exacerbation
  • sinusitis
  • AECB
  • serious gram negative infections
67
Q

What are the 3 kinds of Tetracyclines?

A
  1. ) Tetracycline
  2. ) Monocycline
  3. ) Doxycycline
68
Q

Tetracyclines

A
  • 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
Q

What is the spectrum for tetracycline use?

A
  • broad spectrum use of GP’s and GN’s

- rickettsia, Chlamydia, Mycoplasma

70
Q

What are tetracyclines used to treat?

A
  • community acquired pneumonia
  • Chlamydia
  • syphillis in PCN allergic patients
  • Lyme Disease
  • acne
  • community acquired MRSA
71
Q

What are the adverse drug reactions for tetracyclines?

A
  • GI upset
  • photosensitivity
  • erosive esophagitis (Doxycycline)
  • vestibular symptoms (Minocycline)
72
Q

When do you need to dose adjust tetracyclines?

A

when the CrCl is less than 10

73
Q

Vancomycin

A
  • 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
Q

What is the spectrum for Vancomycin?

A
  • gram positives, including MRSA and MRSE

- moderate anaerobic coverage

75
Q

What are the adverse drug reactions associated with Vancomycin?

A

Redman’s Syndrome- rash on face/chest, flushing, hypotension

  • infuse over 1 hour to prevent Redmans
  • also causes reversible neutropenia
76
Q

clindamycin (Cleocin)

A
  • IV, PO, topical (acne), vaginal

- inhibits protein synthesis

77
Q

What is the spectrum for clindamycin?

A
  • Staph (MRSA too)
  • Strep
  • anaerobes
78
Q

When should clindamycin be used?

A
  • an anaerobic abscess
  • abdominal infection
  • GYN infection
79
Q

Metronidazole (Flagyl)

A
  • IV, PO, vaginal
  • inhibits DNA synthesis
  • pregnancy category B (avoid in 1st trimester)
  • spectrum: anaerobic and amecidie
  • penetrates the CSF
80
Q

When should you use Flagyl?

A
  • abdominal abscesses
  • C. difficile colitis
  • H. pylori
81
Q

Flagyl has a reaction with…

A

alcohol (ETOH)

82
Q

TMP/SMZ

A
  • 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
Q

When is TMP/SMZ contraindicated?

A

-in the 3rd trimester with less than 2 weeks remaining

84
Q

What is the spectrum for TMP/SMZ?

A
  • more than 90% sensitive for Staph infections
  • Strep
  • many GRNs
  • Pneumocystitis
85
Q

TMP/SMZ is the mainstay for the treatment of what?

A
  • uncomplicated UTIs

- DOC for pneumocystitis

86
Q

Who needs to have their kidney function monitored while on TMP/SMZ?

A
  • patient with underlying renal insufficiency

- prolonged therapy patients

87
Q

TMP/SMZ increases the effect of…

A
  • warfarin
  • oral hypoglycemics
  • phenytoin
  • methotrexate
  • cyclosporin
88
Q

What are the adverse drug reactions for TMP/SMZ?

A
  • 10% get a rash
  • photosensitivity
  • CNS disturbances
  • GI symptoms
89
Q

Rifampin

A
  • PO
  • inhibits bacterial RNA synthesis
  • need to monitor LFT’s (can be hepatotoxic)
  • potent cytochrome P450 inhibitor (call pharmacist)
90
Q

What is Rifampin used for?

A
  • TB
  • meningococcal prophylaxis
  • nasal carriers or MRSA
  • synergy for certain S. aureus infections (osteo)
91
Q

Does Rifampin cover MRSA?

A

YES, but CAN’T be used alone as it will rapidly develop resistance

92
Q

What are the adverse drug reactions for Rifampin?

A
  • GI upset
  • rash
  • turns secretions red/orange/brown (urine, sweat, tears, contacts)
93
Q

Linezolid (Zyvox)

A
  • IV, PO (100% bioavailable)
  • oxazolinidone class
  • for MRSA and VRE infections
  • more support for use in serious MRSA infections
94
Q

What are the adverse drug reactions for Linezolid?

A
  • reversible thrombocytopenia

- anemia

95
Q

What is the spectrum of use for Linezolid?

A
  • Staph infections (MRSA)
  • Coag (-) Staph
  • Strep
  • VRE
  • some anaerobes
96
Q

daptomycin (Cubicin)

A
  • IV only
  • covers MRSA, VRSA, VRE
  • used for complicated skin and soft tissue infection
  • good alternative for resistant pathogens
97
Q

tegecyline (Tygacil)

A
  • IV only (tetracycline derivative)
  • covers MRSA, VRE, Strep, enteric GRN’s, bowel anaerobes
  • newer drug that is being utilized more and more
98
Q

What are the 4 kinds of Semisynthetic Glycopeptides?

A
  • all IV only
  • SSSI due to gram (+) organisms, including MRSA
  1. ) Dalbavanacin
  2. ) Oritavancin
  3. ) Telavancin
99
Q

Dalbavanacin

A
  • half life of 6-12 days

- once weekly dosing

100
Q

Oritavancin

A
  • half life around 100 hours
  • once weekly dosing
  • covers VRE
101
Q

Telavancin

A
  • half life of 7-9 hours
  • once daily dosing
  • indicated for MRSA pneumonia and covers VISA and VRSA
102
Q

quinupristin/dalfopristin (Synercid)

A
  • Streptogramin class
  • IV only in central line
  • very rarely used
103
Q

What are the adverse drug reactions for Synercid?

A
  • myalgias

- arthralgias

104
Q

What is the spectrum for Synercid?

A
  • MRSA

- VRE

105
Q

Mupirocin (Bactroban)

A
  • 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
Q

nitrofurantoin (Macrodantin)

A
  • used for Gram Positives, enterococci, E. coli
  • Pregnancy category B
  • less absorption when taken with antacids
  • mainly prescribed by urologists
107
Q

What are the adverse drug reactions for nitrofurantoin?

A
  • nausea
  • vomitting
  • diarrhea
  • turns urine brown
  • TAKE WITH FOOD!
108
Q

What are the warnings and precautions for nitrofurantoin (Macrodantin)?

A
  • G6PD deficiency

- can cause interstitial pulmonary fibrosis with chronic use

109
Q

fidaxomicin (Dificid)

A
  • oral
  • absorbed in GI tract and excreted in the feces
  • abdominal pain is main SE
  • very costly!
110
Q

When is fidazomicin (Dificid) taken?

A

-for C. diff or associated diarrhea (CDAD)

Pharm II (7 decks)

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