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VUSM > Antibiotics > Flashcards

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
Q

macrolides

A
  • 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
Q

doripenem

A

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
Q

disulfiram-like rxn antibiotics

A

cefotetan
cefaclor
metronidazole

28
Q

methicillin

A

penicillanse-resistant penicillin (b-lactam antibiotic)
- not widely available

29
Q

amikacin

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

30
Q

nafcillin

A

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
Q

trimethoprim/ sulfonamide

A

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
Q

rifampin

A

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
Q

why antibiotics fail

A
  • 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
Q

tigecycline

A

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
Q

ceftazidime

A

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
Q

dicloxacillin

A

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
Q

daptomycin

A

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
Q

metronidazole

A

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
Q

directed therapy

A

therapy directed against a spec pathogen (isolated in culture), guided by susceptibility results

40
Q

hepatic excretion antibiotics

A

nafcillin
dicloxacillin
ceftriaxone
moxifloxacin
metronidazole (also renal)
chloramphenicol

41
Q

chloramphenicol

A

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
Q

post antibiotic effect

A

bacterial inhibition persisting for some time after antibiotic levels decrease below the MIC

43
Q

moxifloxacin

A

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
Q

streptomycin

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

45
Q

empiric therapy

A

therapy based on best/educated guess as to likely pathogen/ susceptibilities

46
Q

ampicillin

A

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
Q

Beta-lactam antibiotics

A

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
Q

penicillin G

A

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
Q

good antibiotic against anaerobes

A

cefotetan (2nd generation cephalosporin)

  • also carbapenems (meropenem, doripenem, ertapenem)
  • also metronidazole
50
Q

tetracyclines

A

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
Q

ciprofloxacin

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
- non-respiratory: no pneumococcus
- empiric: UTI, prostatitis, inf diarrhea

52
Q

azithromycin

A

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

53
Q

vancomycin

A

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
Q

cefaclor

A

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
Q

cefotetan

A

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
Q

nosocomial

A

acquired in the hospital

VUSM (4 decks)

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