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Antibiotics Flashcards

1
Q

Beta-Lactams

A

Penicillin, Cephalosporin

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2
Q

Fluoroquinolones

A 
Ciprofloxacin
Gemifloxacin
levofloxacin
Lomefloxacin
Moxifloxacin
norfloxacin
Olfloxacin
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3
Q

Aminoglycoside

A 
Amikacin (Amikin)
Gentamycin (garamycin)
Kanamycin (Kantrex)
Neomycin (mycifradin)
Streptomycin
Tobramycin (Nebcin, Tobrex)
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4
Q

Lincosamides

A

Clindamycin (Cleocin)

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5
Q

Macrolides, Ketolides

A 
Azithromycin
Erythromycin
Clarithromycin
Dirithromycin
Telithromycin
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6
Q

Sulfonamides

A

sulfaslazine (azulfidine)
Mafenide (Sulfamylon)
Sulfadiazine (Silvadene)

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7
Q

trimethoprim

A

proloprim

Trimpex

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8
Q

nitrofurantoin

A

Furadantin
macrodantin
Fosfomycin (Monurol)

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9
Q

Trimethoprim-sulfamethoxazole (Combo med)

A

Bactrim
septra
TMP-SMZ

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10
Q

Tetracyclines

A

Doxycycline
Minocycline
Oxytetrecycline
Tetracycline

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11
Q

Lipoglycopeptides

A

Vancomycin
Telavancin (Vibativ)
Dalbavancin (zeven)

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12
Q

Antimycobacterials

A 
Capreomycin (IM)
Ethambutol
Ethionamide
Isoniazide (IM/PO)
Pyrazinamide
Rifampine
Rifabutin
Rifapentine
Strepomycin (IM)
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13
Q

causes of antimicrobial resistance

A 
Recent use of antibiotics
overuse of broad spectrum antibiotics
Age younger than 2 OR older than 65
daycare center attendance
exposure to young children
multiple medical comorbidities
immunosuppression
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14
Q

How are local resistance patterns identified

A

by monitoring the antibiogram in the local laboratory

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15
Q

what vaccine has decreased resistance

A

Pneumococcal vaccine

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16
Q

natural or intrinsic resistance

A

Microorganism that do not act on a specific enzyme system or biological system are not affected by the particular drug that attack this system

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17
Q

the ways anti-resistance develops

A
  • produces an enzyme that deactivates the drug
  • changing cellular permeability to prevent the drug from entering the cell
  • alter transport systems to exclude the drug from active transport into the cell
  • alter binding sites on the membrane or ribosomes which no longer accept drugs
  • producing a chemical that acts as an antagonist to the drug
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18
Q

way to prevent antibiotic resistance

A
  • limit the use of antimicrobial agents to treatment of specific pathogens sensitive to the drug being used
  • make sure dose is high enough and duration is long enough
  • be cautious about the indiscriminante use of antiinfectives
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19
Q

identification of pathogen

A

by culture

-swab is done and put on agar plate to grow, staining technique and microscopic exam to identify bacterium

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20
Q

sensitivity of pathogen

A
  • this can show what drugs are capable of controlling the particular microorganism (especially important for microorganism that are known to have resistant strains)
  • this is done along with a culture and it identifies the pathogen and proper drug for tx
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21
Q

factors that can affect prescribing anti-infectives

A
  • identification of wrong pathogen

- selection of right drug (causes the least complications for pt, and most effective against the pathogen involved)

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22
Q

Synergistic

A

Synergism comes from the Greek word “synergos” meaning working together. It refers to the interaction between two or more “things” when the combined effect is greater than if you added the “things” on their own

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23
Q

combination therapy

A
  • uses smaller dosages of each drug
  • some of these drugs are synergistic
  • used in infections caused by more than one microorganism, and may react to different anti-infectives
  • the combined effects of different drugs delay emergence of resistant strains
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24
Q

when are prophylaxis anti-infectives used

A
  • people traveling to an area with malaria
  • pt under going GI or genitourinary sx
  • pt with known cardiac valve disease, valve replacement, and other conditions require invasive procedures
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25
Q

pharmocodynamics: PCN

A

inhibit the biosynthesis of peptidoglycan bacterial cell wall (cell wall destroyer)

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26
Q

4 PCN subclasses

A

1) penicillinase-sensitive or natural pcn’s
2) Aminopenicillins
3) Penicillinase-resistant or anti staphylococcal pcn’s
4) Anti-pseudomonal or extended-spectrum pcn’s

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27
Q

Bacteriostatic agent

A

A bacteriostatic agent or bacteriostat, abbreviated Bstatic, is a biological or chemical agent that stops bacteria from reproducing, while not necessarily killing them otherwise

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28
Q

natural PCN sensitivity

A
  • Streptococcus
  • some Enterococcus
  • some non-Penicillinase-producing Staphlococcus
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29
Q

Aminopenicillins

A 
more gram negatives; 
used for gram negative urinary and GI pathogens 
-E coli, 
-proteus mirabilis
-salmonella
-some Shigella
-Enterococcus faecalis
Active against gram negative respiratory pathogens;
-Moraxella catarrhalis  
-Haemophilus influenza type B
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30
Q

what are some beta-lactamase inhibitors used in combination with PCN to help broaden their spectrum

A
  • Clavulanate
  • slbactam
  • tazobactam
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31
Q

pharmacokinetics of penicllins

A

-well absorbed in GI tract (but unstable in acid)
dicloxacllin, and amoxicillin better absorbed than ampicillin
-bound to proteins with good distribution to most tissues
-small amount is metabolized, most excreted in urine
probenecid prolongs half-life and increases risk for toxicity

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32
Q

adverse drug reactions of penicillins

A

Adverse reactions

  • a maculopapular rash occurs 7-10 days into treatment
  • GI diarrhea N/V
  • fungal overgrowth
  • c-difficile colitis
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33
Q

desensitization therapy

A

Through your body’s exposure to small, injected amounts of a particular allergen, in gradually increasing doses, your body builds up immunity to the allergen(s) to which you are allergic

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34
Q

Allergic reaction: to PCN

A
  • they occur within 2-30 mins

- patients maybe given desensitization therapy

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35
Q

what category in pregnancy is PCN

A

Category B

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36
Q

Clinical use PCN

A
  • commonly used for infections seen in primary care
  • amoxicillin is first line for acute otitis media
  • PCN for streptococcal pharyngitis
  • amoxicillin/clavulanate first line for infection in any kind of bites
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37
Q

PCN monitoring

A

return to office for evaluation of symptom relief, are they getting better?

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38
Q

Cephalosporins

A

Beta-Lactams

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39
Q

Cephalosporins Pharmacodynamics

A

inhibit mucopeptide synthesis in the bacterial cell wall

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40
Q

first generation cephalosporin

A
  • used for skin and soft tissue infections

- primarily active against gram-positive bacteria S Aureus and S. epidermidis

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41
Q

second generation cephalosporin

A

active against same as 1st generation. Plus Klebsiella, Proteus, E coli

42
Q

third generation cephalosporin

A
  • used for broader indications

- more active against gram negative bacteria

43
Q

fourth generation cephalosporin

A
  • resistant to beta-lactamase

- primarily active against gram positive bacteria

44
Q

cephalosporins pharmacokinetics

A

oral absorbs from GI tract, widely distributes to most tissues, some highly bound to proteins, some are metabolized to less active compounds, most excreted via kidneys in various degrees

45
Q

Cephalosporin adverse drug reactions

A 
allergies
skin rashes
arthralgia (pain in the joint)
coagulation abnormalities
anemia
neutropenia
leukopenia
thrombocytosis (body produces to much platelets)
fever
seizures
renal/hepatic  failure
46
Q

clinical use of cephalosporin

A
  • used for therapeutic failure in AOM
  • 1st generation for strep pharyngitis and skin infections
  • cephalexin, cefpodoxime, cefixime can be prescribed as second line for UTI
  • ceftriaxone and cefixime used for GC/chlamydia
  • cefpodoxime, cefuroxime or parenteral ceftriaxone followed by oral cefpodoxime are used for community acquired pneumonia
47
Q

monitoring for cephalosporin

A

monitor for diarrhea (c-diff)

renal function if prolonged therapy

48
Q

patient education for cephalosporin

A

use as prescribed

49
Q

fluoroquinolones pharmacodynamics

A

interfere with bacterial enzymes required for synthesis of bacterial DNA (noted for extensive gram negative activity)

50
Q

fluoroquinolones are not recommended for what age?

A
51
Q

no longer recommended for what resistant strains

A

G/C

resistant TB

52
Q

Fluoroquinolones pharmacokinetics

A

well absorbed, take on empty stomach for best absorption

53
Q

Adverse drug reactions of Fluoroquinolones

A

-BLACK BOX warning for tendonitis/tendon rupture
elderly at a higher risk, can have delayed onset 120 days to months after administration
-GI-pseudo membranous colitis
-CNS; sleep disorders, dizziness, acidosis
-renal/hepatic failure
-CV angina, atrial flutter
-avoid pregnancy
-do not prescribe to children under 18

54
Q

clinical use for Fluoroquinolones

A
  • complicated UTI, pyelonephritis, infections, chronic bacterial prostatitis
  • pneumonia/bronchitis exacerbation
  • PCN resistant S pneumonia, skin infections bone/joint infections, complicated intra-abdominal, infectious diarrhea
55
Q

Monitoring Fluoroquinolones

A

watch for prolonged use, ECG with at risk patients before prescribing moxifloxacin, alcohol use, monitor for tendinitis/rupture

56
Q

Fluoroquinolones patient education

A
  • food delays absorption
  • many drug interactions
  • take a full glass of water
  • may cause dizziness
  • if tendon tenderness occurs stop medication
57
Q

Aminoglycosides

A

A group of powerful antibiotics used to treat serious infections caused by gram-negative aerobic bacilli (bactericidal)

58
Q

Aminoglycosides action

A

inhibits protein synthesis in susceptible strains of gram-negative bacteria causing cell death

59
Q

Aminoglycosides Pharmacokinetics

A
  • poorly absorbed in GI tract, but rapidly absorbed after IM injection reaching peak within 1 hour
  • widely distributed throughout the body crossing placenta and entering breast milk
  • excreted unchanged in the urine and have an average half-life of 2-3 hours
  • depend on the kidney for excretion and are toxic to the kidney
60
Q

aminoglycosides contraindications

A

known allergies
renal or hepatic disease
hearing loss

61
Q

Aminoglycosides adverse effects

A

ototoxcity and nephrotoxcity

62
Q

Aminoglycosides drug to drug interactions

A

Diuretics

neuromuscular blockers

63
Q

Lincosamides: Clindamycin pharmacodynamics

A

inhibits protein synthesis: no gram negative activity, has gram positive activity: corynebacterium acnes, gardnarella vaginalis, some MRSA

64
Q

Clindamycin pharmacokinetics

A

PO dosing completely absorbed not affected by gastric acid

65
Q

Clindamycin Adverse effects

A 
Black Boxed warning for severe colitis
derm:rash
burning
itching
erythema (reddening of skin)
transient eosinophelia
neutropenia
thrombocytopenia
66
Q

Clindamycin Clinical use

A

1st line therapy for MRSA in some area
infection in PCN allergic pt
DSRP infections
Dental infections

67
Q

Clindamycin Rational drug selection

A

considered second line therapy narrow spectrum of aerobic activity
** first line in special population (pregnancy and children)

68
Q

Clindamycin monitoring

A

stop medication if significant diarrhea occurs

69
Q

Clindamycin patient education

A

finishing therapy and warn them of ADR Diarrhea

70
Q

Erythromycin pharmacodynamics

A
  • Inhibits RNA dependent protein synthesis
  • weak bases, activity increases in alkaline media
  • Atypical and intracellular organism commonly resistant to beta-lactam antibiotics are often susceptible
  • Cross resistance seen to all in class
71
Q

Erythromycin Pharmacodynamics

A
  • well absorbed in duodenum
  • potent inhibitor of CYP 450 3A4
  • combined with statins may increase risk for myopathy
  • Exhibit enterohepatic recycling which can lead to build up in the system and can cause n/v tissue levels are higher than serum levels
72
Q

Erythromycin contraindications/ precautions

A

most are safe in pregnancy and children

73
Q

Erythromycin ADR’s

A

Dose related GI: N/V, abd pain, cramping, diarrhea

Skin: urticara, Bullous eruptions, eczema, and stevens johnsons syndrome

74
Q

Erythromycin Drug interactions

A

inhibitors of CYP 3A4

75
Q

Clinical use of Erythromycin

A
  • drug choice for community acquired pneumonia (Mycoplasma)
  • chlamydia
  • pertussis
  • H. Pylori
  • Chronic bronchitis
76
Q

Erythromycin rational drug selection

A
  • often as alternatives for PCN allergies
  • increasing resistance
  • not appropriate for treating AOM or sinusitis
77
Q

Erythromycin monitoring

A
  • monitored for altered response to concurrent medications metabolized by CYP 450 3A4 or 2C9
  • Hepatic/Renal impairment
  • hearing loss
78
Q

Erythromycin patient education

A

ADR’s

drug interactions

79
Q

Sulfonamides

A

block folic acid synthesis

80
Q

Trimethoprim

A

inhibits DNA synthesis

81
Q

Nitrofurantoin

A

may inhibit acetyl co enzymes

82
Q

Sulfonamides, Trimethoprim, and Nitrofurantoin Inhibits what bacteria

A

inhibit both gram positive and gram negative bacteria

E-coli, S. Pyogenes, S pneumoniae, H influenza, and some protozoa. resistance an issue

83
Q

Sulfonamides, Trimethoprim, and Nitrofurantoin ADR’s

A

GI: Anorexia, N/V, diarrhea, stomatitis, rashes, increased hypersensitivity reactions, dizziness, drug interactions

84
Q

Sulfonamides, Trimethoprim, and Nitrofurantoin; what to avoid?

A

G6PD deficiency

85
Q

Clinical uses: Sulfonamides, Trimethoprim, and Nitrofurantoin

A
  • most commonly used with UTI infections

- MRSA is susceptible in some areas

86
Q

rational drug selection: Sulfonamides, Trimethoprim, and Nitrofurantoin

A

low cost alternative for > 2months and PCN allergy

87
Q

monitoring: Sulfonamides, Trimethoprim, and Nitrofurantoin

A

culture and sensitivity-if treating UTI
long term use check CBC
CXR for Pt’s that develop a cough when on nitrofurantoin

88
Q

Pt education: Sulfonamides, Trimethoprim, and Nitrofurantoin

A

Finish full course ADR’s resistance

89
Q

Tetracycline pharmacodynamics

A

tetracycline and doxycycline, they bind reversibly to the 30S subunit of the bacterial ribosome

90
Q

Tetracycline pharmacokinetics

A

food decreases absorption

milk and cheese decreases absortion of tetracycline

91
Q

Tetracycline precautions/contraindications

A

Do not prescribe to pregnant or lactating women.

do not prescribe to children

92
Q

Tetracycline drug interactions

A

many drug interactions

93
Q

Tetracycline: clinical use

A
  • Doxycycline is considered first line of therapy for C. trachomatis and ureaplasma urealyticum
  • tetracycline and minocycline used to treat P. acnes
  • Some H. Pylori regimens include tetracycline
94
Q

Tetracycline: rational drug selection

A

Doxycycline and minocycline can be taken with food

95
Q

Tetracycline: PATIENT EDUCATIONS

A

administration, ADR’s, avoid in pregnancy

96
Q

Lipoglycopeptides: Pharmacodynamics

A
  • used for severe gram positive infectionssucha as MRSA resistant to first line antibiotics
  • inhibits cell wall synthesis
97
Q

Lipoglycopeptides: pharmacokinetics

A

Poor oral absorption, given IV

98
Q

Lipoglycopeptides: ADR’s

A

Ototoxicity (transient or permanent)
Nephrotoxcity
“Red Man” Syndrome if infused too fast

99
Q

Lipoglycopeptides: clinical use

A

serious gram positive resistant to other medications

100
Q

Lipoglycopeptides: monitoring

A

hearing and renal function

101
Q

Lipoglycopeptides: pt education

A

administration

ADR’s

advanced health assessment (13 decks)

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