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Antibiotics Flashcards

1
Q

T/F cephalosporins cover enterococci

A

false!
do NOT cover enterococci!

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2
Q

amoxicillin

A

aminopenicillin (b-lactam antibiotic)
MOA: bind PBP, inh cell wall synth
Pharm: oral delivery, renal excretion
Tox: B-lactam allergy
Spectrum: streptococci, gram pos anaerobes, some enterics (no staph)
- empiric: odentogenic inf, strept throat, UTI

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3
Q

amoxicillin-clavulanate (Unasyn)

A

beta-lactam/ beta-lactamase inhibitor (b-lactam antibiotic)
- non-pseudomonal
MOA: bind PBP, inh cell wall synth
Pharm: oral delivery, renal clearance
Tox: b-lactam allergy, clavulanate –> cholestatic liver injury
Spectrum: b-lactamase inhibitor improves coverage:
- MSSA (now get staph!), everything except pseudomonas (gram + and - anaerobes, enterics, respiratory gram negs)
- empiric: URTI, aspiration pneumonia, bite wounds

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4
Q

piperacillin

A

extended spectrum antibiotic (b-lactam antibiotic)
MOA: bind PBP, inh cell wall synth
Pharm: IV delivery, renal excretion
Tox: B-lactam allergy, provides a moderate sodium load (consider in CHF pts)
Spectrum: pseudomonas, strep, gram pos anaerobes (not staph)
- empiric: used in combo for neutropenic fever, nosocomial inf, intra-abdom inf

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5
Q

erythromycin

A

MOA: inh protein synth (bacteriostatic)
Pharm:
Tox: abdom cramps, QT prolongation
Resist: erm gene, mef (A) gene
Spectrum: “atypicals”, GPs, some mycobacteria

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6
Q

clindamycin

A

MOA: inh protein synth (bacteriostatic)
Pharm:
Tox: diarrhea (C diff)
Resist: cannot penetrate membrane GNs
- D test: if looks like D around clindamycin on bact lawn, is positive for erythromycin-induced clindamycin resistance (erm gene)
Spectrum: gram pos, anaerobes, also co-administed to prevent toxin formation (TSS) (b/c is a prot synth inhibitor)

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7
Q

ceftriaxone

A

3rd generation cephalosporin (b-lactam antibiotic)
- nonpseudomonal
MOA: bind PBP, inh cell wall synth
Pharm: IV delivery, hepatic excretion. Good CNS penetration!
Tox: biliary sludge/ pseudocholylithiasis, B-lactam allergy
Spectrum: strep, MSSA, gn enterics, gn respiratory (no anaerobes)
- empiric: meningitis (covers pneumococcus, meningococcus, but NOT listeria)
- directed: lyme disease

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8
Q

anti-pseudomonal antibiotics

A

piperacillin
piperacillin-tazobactam
ceftazidime
cefipime
meropenem
doripenem
aztreonam
gentamicin
amikacin
streptomycin
ciprofloxacin
moxifloxacin
levofloxacin

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9
Q
A
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10
Q

meropenem

A

carbapenem (b-lactam antibiotic)
- anti-pseudomonal
MOA: bind PBP, inh cell wall synth
Pharm: IV delivery, renal excretion
Tox: seizures
Spectrum: broadest agent available! covers EVERYTHING, including pseudomonas (and enterococcus)!
- empiric: neutropenic fever, nosocomia pneumonia, intraabdom inf, diabetic skin and soft tissue inf

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11
Q

linezolid

A

MOA: inh protein synth (bacteriostatic)
Pharm: good oral bioavail
Tox: a monoamine oxidase inhibitor! - avoid aged, fermented, pickled foods. avoid SSRIs. also lactic acidosis
Spectrum: good against resistant GPs

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12
Q

clarithromycin

A

MOA: inh protein synth (bacteriostatic)
Pharm:
Tox: abdom cramps, QT prolongation
Resist: erm gene, mef (A) gene
Spectrum: “atypicals”, GPs, some mycobacteria

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13
Q

cefotaxime

A

3rd generation cephalosporin (b-lactam antibiotic)
- nonpseudomonal
MOA: bind PBP, inh cell wall synth
Pharm: IV delivery, renal excretion. Good CNS penetration!
Tox: B-lactam allergy
Spectrum: strep, MSSA, gn enterics, gn respiratory (no anaerobes)
- empiric: meningitis (covers pneumococcus, meningococcus, but NOT listeria)
- directed: lyme disease

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14
Q

aztreonam

A

monobactam (b-lactam antibiotic)
MOA: bind PBP, inh cell wall synth
Pharm: IV delivery, renal excretion
Tox: NO cross reactivity w/ other b-lactams! can be used in PCN allergic pts!
Spectrum: Pseudomonas + enterics + GN respiratory (GNs only!)
- empiric: anti pseudomonal b lactam in pt w/ allergy

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15
Q

cefipime

A

4th generation cephalosporin (b-lactam antibiotic)
- anti-pseudomonal
MOA: bind PBP, inh cell wall synth
Pharm: IV delivery, renal excretion. Good CNS penetration!
Tox: B-lactam allergy
Spectrum: pesudomonas + strep, MSSA, gn enterics, gn respiratory (no anaerobes) [3rd gen activity]
- empiric: neutropenic fever, nosocomial pneumonia

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16
Q

piperacillin-tazobactam (Zosyn)

A

beta-lactam/ beta-lactamase inhibitor (b-lactam antibiotic)
- pseudomonal
MOA: bind PBP, inh cell wall synth
Pharm: IV delivery, renal clearance
Tox: b-lactam allergy
Spectrum: b-lactamase inhibitor improves coverage:
- pseudomonas!, MSSA. gram + and - anaerobes, enterics, respiratory gram negs
- empiric: intra-abdominal & gyn inf, diabetic foot inf, health-care acquired pneumonia, neutropenic fever (combo)

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17
Q

cephalexin

A

1st generation cephalosporin (b-lactam antibiotic)
MOA: bind PBP, inh cell wall synth
Pharm: oral delivery, renal excretion
Tox: b-lactam allergy
Spectrum: strept, MSSA, some enterics (remember these are GN)
- less suscept to b-lactamases than natural pcns, more suscept than later gen cephalosporins
- 1st gen cephalosporins rarely used

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18
Q

levofloxacin

A

quinolone
MOA: inhibits NA synth (DNA gyrase), bacteriocidal (concentration-dependent killing)
Pharm: oral and IV delivery, renal clearance
- Good tissue penetration (CNS, bone)
- GI absorption = 100% (dec by divalent cations)
Tox: Arthropathy (spontaenous achilles tendon rupture), some CNS
Spectrum: pseudomonas (only oral drugs against psuedomon!), GN enterics, GN respiratory
- RESPIRATORY: COVERS pneumococcus
- empiric: UTI, prostatitis, community acquired pneumonia

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19
Q

penicillin V, VK

A

natural PCN (b-lactam antibiotic)
MOA: bind PBP, inh cell wall synth
Pharm: oral delivery, renal excretion
Tox: B-lactam allergy
Spectrum: streptococci, gram pos anaerobes (no staph)
- empiric: odentogenic inf, strept throat, deep neck inf, aspiration pneumonia or lung abscess

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20
Q

doxycycline

A

2nd gen tetracycline
MOA: inh prot synth, bacteriostatic
Pharm: oral delivery, renal excr
Tox: skin and teeth SEs (photosens, pigmentation)
Resist: tet genes - abio cannot disrupt synth
Spectrum: no pseudomonas, wide range but lots of resistance. good for obligate intracellulars

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21
Q

gentamicin

A

aminoglycoside antibiotic
MOA: inhibits protein synthesis, bacteriocidal (concentration-dependent killing)
Pharm: IV delivery, renal excretion. POST ANTIBIOTIC EFFECT - single daily dosing
Toxicity: Nephrotoxicity, ototoxicity, neuromuscular blockade (rare)
Spectrum: pseudomonas + enterics + gn respiratory (GNs only! sim to aztreonam)
- synergistic if used with cell wall agent against GPs
- empiric (in combo): neutropenic fever, pyelonephritis, bacterial endocarditis

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22
Q

ertapenem

A

carbapenem (b-lactam antibiotic)
- odd guy out. no anti-pseudomonal activity
MOA: bind PBP, inh cell wall synth
Pharm: IV delivery, renal excretion
Tox: seizures
Spectrum: no pseudomonas, NO enterococci - covers everything else: gp/gn anerobes, strept, resp, enterics, MSSA
- empiric: intra-abdom inf, diabetic skin and soft tissue inf

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23
Q

cefazolin

A

1st generation cephalosporin (b-lactam antibiotic)
MOA: bind PBP, inh cell wall synth
Pharm: IV delivery, renal excretion
Tox: b-lactam allergy
Spectrum: strept, MSSA, some enterics (remember these are GN)
- less suscept to b-lactamases than natural pcns, more suscept than later gen cephalosporins
- 1st gen cephalosporins rarely used

24
Q

ampicillin-sulbactam (Augmentin)

A

beta-lactam/ beta-lactamase inhibitor (b-lactam antibiotic)
- non-pseudomonal
MOA: bind PBP, inh cell wall synth
Pharm: IV delivery, renal clearance
Tox: b-lactam allergy
Spectrum: b-lactamase inhibitor improves coverage:
- MSSA (now get staph!), everything except pseudomonas (gram + and - anaerobes, enterics, respiratory gram negs)
- empiric: URTI, aspiration pneumonia, bite wounds

25
macrolides
- erythromycin, azithromycin, clarithromycin MOA: inh protein synth (bacteriostatic) Pharm: Tox: abdom cramps, QT prolongation Resist: erm gene, mef (A) gene Spectrum: "atypicals", GPs, some mycobacteria
26
doripenem
carbapenem (b-lactam antibiotic) - anti-pseudomonal MOA: bind PBP, inh cell wall synth Pharm: IV delivery, renal excretion Tox: seizures Spectrum: covers EVERYTHING, including pseudomonas (and enterococcus)! - empiric: neutropenic fever, nosocomia pneumonia, intraabdom inf, diabetic skin and soft tissue inf
27
disulfiram-like rxn antibiotics
cefotetan cefaclor metronidazole
28
methicillin
penicillanse-resistant penicillin (b-lactam antibiotic) - not widely available
29
amikacin
aminoglycoside antibiotic MOA: inhibits protein synthesis, bacteriocidal (concentration-dependent killing) Pharm: IV delivery, renal excretion. POST ANTIBIOTIC EFFECT - single daily dosing Toxicity: Nephrotoxicity, ototoxicity, neuromuscular blockade (rare) Spectrum: pseudomonas + enterics + gn respiratory (GNs only! sim to aztreonam) - synergistic if used with cell wall agent against GPs - empiric (in combo): neutropenic fever, pyelonephritis, bacterial endocarditis
30
nafcillin
penicillanse-resistant penicillin (b-lactam antibiotic) MOA: bind PBP, inh cell wall synth Pharm: IV delivery, hepatic excretion Tox: B-lactam allergy Spectrum: MSSA only - empiric: skin and soft tissue inf (if MRSA is not suspected)
31
trimethoprim/ sulfonamide
MOA: prevents synth of folic acid (anti-metabolite). we don't synth folate, so won't interfere w/ mammalian metabolism - bacteriostatic Tox: hypersens, can hurt kidneys, hemolysis Resist: alter enzyme p'way Spectrum: GP, GN, some protozoa
32
rifampin
MOA: inhibit RNA synth, bacteriocidal Pharm: Tox: ORANGE SECRETIONS - Daily therapy - hepatitis, lupus-like syndrome - Intermittent therapy - flu-like (sensitization - big problem!) Resistance: occurs frequently (rpoB gene), so use in COMBO therapy Spectrum: mycobacteria (TB), gram positives
33
why antibiotics fail
- wrong drug (treat for GN or GP?) - wrong dose - wrong diagnosis - wrong route of administration (not all are PO!) - wrong duration - inadequate drug penetration - acquired resistance - infections on prosthetic device - severe immunosuppression (pt just can't fight off disease) - nonadherence
34
tigecycline
3rd gen tetracycline MOA: inh prot synth, bacteriostatic Pharm: IV delivery, renal excr Tox: skin and teeth SEs (photosens, pigmentation) Resist: tet genes - abio cannot disrupt synth Spectrum: no pseudomonas, wide range, improved over earlier gen. good for obligate intracellulars
35
ceftazidime
3rd generation cephalosporin (b-lactam antibiotic) - anti-pseudomonal MOA: bind PBP, inh cell wall synth Pharm: IV delivery, renal excretion. Good CNS penetration! Tox: B-lactam allergy Spectrum: MINIMAL act against GPs. pesudomonas + enterics ONLY - empiric: neutropenic fever, nosocomial pneumonia
36
dicloxacillin
penicillanse-resistant penicillin (b-lactam antibiotic) MOA: bind PBP, inh cell wall synth Pharm: oral delivery, hepatic excretion Tox: B-lactam allergy Spectrum: MSSA only - empiric: skin and soft tissue inf (if MRSA is not suspected)
37
daptomycin
MOA: disruption of bact cell membrane - bacteriocidal Pharm: IV delivery Tox: do NOT use w/ pneumonia -- binds to surfactant (ineffective), elevated creatinine phophokinase Spectrum: GPs, including anaerobes
38
metronidazole
MOA: inh DNA synth - bacteriocidal, concentration-depending killing Pharm: both IV and oral (good bioavail), good penetration to CNS + abscesses, hepatic AND renal excretion Tox: disulfiram reaction w/ alcohol, metallic taste, CNS SEs (rare) Spectrum: PURE ANAEROBE, + parasites (giardia, entamoeba histolytica, trichomonas vaginalis) - empiric: anaerobic GI flora, bacterial vaginosis, C diff colitis, brain abscesses (in combo), intra-abdom inf (in combo)
39
directed therapy
therapy directed against a spec pathogen (isolated in culture), guided by susceptibility results
40
hepatic excretion antibiotics
nafcillin dicloxacillin ceftriaxone moxifloxacin metronidazole (also renal) chloramphenicol
41
chloramphenicol
MOA: inh of protein synthesis - bacteriostatic Pharm: IV delivery, hepatic metabolism, CNS penetration Tox: reversible, dose-dependent pancytopenia. aplastic anemia (BM SUPPRESSION), GRAY BABY SYNDROME (cardiac toxicity) Spectrum: lots of activity, no pseudomonas - empiric: NONE IS US! too toxic. meningitis in b-lactam allergic pts, RMSF in pregnancy
42
post antibiotic effect
bacterial inhibition persisting for some time after antibiotic levels decrease below the MIC
43
moxifloxacin
quinolone MOA: inhibits NA synth (DNA gyrase), bacteriocidal (concentration-dependent killing) Pharm: oral and IV delivery, hepatic clearance - does NOT penitrate to urine (cannot treat UTIs w/ moxifloxacin!!) - GI absorption = 100% (dec by divalent cations) Tox: Arthropathy (spontaenous achilles tendon rupture), some CNS Spectrum: pseudomonas (only oral drugs against psuedomon!), GN enterics, GN respiratory - respiratory: COVERS pneumococcus - empiric: community acquired pneumonia (NOT UTIs!)
44
streptomycin
aminoglycoside antibiotic MOA: inhibits protein synthesis, bacteriocidal (concentration-dependent killing) Pharm: IV delivery, renal excretion. POST ANTIBIOTIC EFFECT - single daily dosing Toxicity: Nephrotoxicity, ototoxicity, neuromuscular blockade (rare) Spectrum: pseudomonas + enterics + gn respiratory (GNs only! sim to aztreonam) - synergistic if used with cell wall agent against GPs - empiric (in combo): neutropenic fever, pyelonephritis, bacterial endocarditis
45
empiric therapy
therapy based on best/educated guess as to likely pathogen/ susceptibilities
46
ampicillin
aminopenicillin (b-lactam antibiotic) MOA: bind PBP, inh cell wall synth Pharm: oral/IV delivery, renal excretion Tox: B-lactam allergy Spectrum: streptococci, gram pos anaerobes, some enterics (no staph) - empiric: odentogenic inf, strept throat, UT
47
Beta-lactam antibiotics
MOA: target penicillin binding proteins (PBPs), inhibit cell wall synth - bacteriocidal, time-dependent killing Resistance: b-lactamases, porin mutations, PBP alterations, efflux pumps Toxicity: B lactam allergy. Immediate - do NOT give another b-lactam (anaphylaxis risk); Delayed - rash, OK to try other classes of B-lactams. Also rare: TEN/SJS Classes: Natural PCNs, Aminopcns, pcnase-res pcns, ESPs, b lactam/b-lactamase inh, cephalosporins, monobactams
48
penicillin G
natural PCN (b-lactam antibiotic) MOA: bind PBP, inh cell wall synth Pharm: IV delivery, renal excretion Tox: B-lactam allergy Spectrum: streptococci, gram pos anaerobes (no staph) - empiric: odentogenic inf, strept throat, deep neck inf, aspiration pneumonia or lung abscess
49
good antibiotic against anaerobes
cefotetan (2nd generation cephalosporin) - also carbapenems (meropenem, doripenem, ertapenem) - also metronidazole
50
tetracyclines
1st gen: tetracycline (outdated) 2nd: doxycycline 3rd: tigecycline MOA: inh prot synth, bacteriostatic Pharm: tetra + doxy po, tigecycline IV; renal excr Tox: skin and teeth SEs (photosens, pigmentation) Resist: tet genes - abio cannot disrupt synth Spectrum: no pseudomonas, wide range but lots of resistance. good for obligate intracellulars
51
ciprofloxacin
quinolone MOA: inhibits NA synth (DNA gyrase), bacteriocidal (concentration-dependent killing) Pharm: oral and IV delivery, renal clearance - Good tissue penetration (CNS, bone) - GI absorption = 100% (dec by divalent cations) Tox: Arthropathy (spontaenous achilles tendon rupture), some CNS Spectrum: pseudomonas (only oral drugs against psuedomon!), GN enterics, GN respiratory - non-respiratory: no pneumococcus - empiric: UTI, prostatitis, inf diarrhea
52
azithromycin
MOA: inh protein synth (bacteriostatic) Pharm: Tox: abdom cramps, QT prolongation Resist: erm gene, mef (A) gene Spectrum: "atypicals", GPs, some mycobacteria
53
vancomycin
MOA: inh cell wall synth (bacteriocidal, time-dependent killing) Pharm: IV delivery - not absorbed PO (except used for C diff treatment), renal excretion - dose based on troughs Tox: RED MANS SYND (due to histamine release w/ rapid infusion), ototoxicity, nephrotoxicity, reversible neutropenia Resistance: Van A-E genes (vanc cannot bind) Spectrum: gram POS only!
54
cefaclor
2nd generation cephalosporin (b-lactam antibiotic) MOA: bind PBP, inh cell wall synth Pharm: oral delivery, renal excretion Tox: b-lactam allergy, MTT moiety --\> disulfiram-like rxn with alcohol consumption Spectrum: strept, MSSA, some enterics + gn respiratory - empiric: URTI
55
cefotetan
2nd generation cephalosporin (b-lactam antibiotic) MOA: bind PBP, inh cell wall synth Pharm: IV delivery, renal excretion Tox: b-lactam allergy, MTT moiety --\> disulfiram-like rxn with alcohol consumption Spectrum: strept, MSSA, some enterics + gn respiratory + gp/gn anerobes - empiric: mixed aerobe/anaerobe inf
56
nosocomial
acquired in the hospital

VUSM (4 decks)

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