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Pharmacology > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

What are the MC and second MC antibiotic MOAs?

A

1 = inhibition of cell wall synthesis

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2
Q

Important aerobic gram positive cocci

A

1) Staphylococci (S. aureus, Coag-negative staph)
2) Streptococci (S. pneumoniae,Group B Strep, Viridans Strep)
3) Enterococci (E. faecalis, E. faecium)

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3
Q

Important aerobic gram negative rods

A

1) E. coli
2) K. pneumoniae
3) Serratia (Enterobacteriaceae)
4) H. influenza
5) . P. aeruginosa

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4
Q

Important aerobic gram negative cocci

A

1) Moraxella catarrhalis
2) N. gonorrhoeae
3) N. meningitidis

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5
Q

Important atypical respiratory aerobes

A

1) Legionella spp.
2) Mycoplasma pneumoniae
3) Chlamydia pneumoniae

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6
Q

Important anaerobes

A

1) True anaerobes (gut): Bacteroides fragilis and C. diff

2) Oral anaerobes: Prevotella and Peptostreptococcus

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7
Q

MIC

A

minimum inhibitory concentration

(dilution test to determine microbial sensitivity)

Note: many drugs will not reach their MIC in certain tissues

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8
Q

MBC

A

minimum bactericidal concentration

-cidal = kills bacteria

(dilution test to determine microbial sensitivity)

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9
Q

Penicillins MOA

A

B-Lactam

inhibit cell wall synthesis by binding to penicillin binding proteins (PBPs)

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10
Q

How are Penicillins differentiated?

A

By their side chains

different penicillins target different bacteria and have different resistance profiles

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11
Q

Penicillins resistance

A

1) B-lactamases - can cleave beta-lactam ring in center of Penicillins and render them inactive; doesn’t affect all penicillins
2) Altered PBPs

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12
Q

Natural penicillins

A

1) Penicillin G (IV)

2) Penicillin VK (PO)

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13
Q

Aminopenicillins

A

1) Amoxicillin
2) Ampicillin
3) Amoxicillin + Clavulanate (Augmentin)

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14
Q

Penicillinase-resistance penicillins

A

1) Methicillin
2) Nafcillin
3) Cloxacillin
4) Dicloxacillin

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15
Q

Extended-Spectrum Penicillins

A

1) Piperacillin
2) Ticarcillin

**These are IV only

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16
Q

Natural Penicillins spectrum

A

1) Gram-positive cocci
2) Neisseria
3) Most oral anaerobes

*Not effective against gram-neg aerobes or beta-lactamase producing organisms

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17
Q

What is Penicillins the DOC for?

A

N. meningitidis

Syphilis

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18
Q

Penicillinase-resistance penicillins spectrum

A

1) Gram-positive cocci (including B-lactamase producers)
2) some Streptococci
3) Oral anaerobes

*Not effective against gram-negative aerobes

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19
Q

Penicillinase-resistance penicillins are DOC for

A

MSSA (methicillin sensitive Staph. aureus)

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20
Q

Aminopenicillins MOA

A

binds to PBPs and inhibits synthesis in bacterial cell wall

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21
Q

Aminopenicillins spectrum

A

1) Some gram negative organisms
2) some gram positive organisms (Strep, Enterococci)
3) oral anaerobes

*Note effective against B-lactamase producing organisms

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22
Q

T/F: Aminopenicillins are the DOC for UTIs

A

FALSE

only use for UTI if you know its caused by enterococci

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23
Q

Extended-Spectrum Penicillins

A

1) Gram negative infx (esp. good again Pseudomonas aeruginosa)
2) Some gram positive (Strep, Staph, Mb Enterococci)
3) Oral anaerobes
4) some true anaerobes

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24
Q

Extended-Spectrum Penicillins are indicated for

A

severe infections

esp. useful for tx Pseudomonas

Broad Spectrum

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25
Q

Penicillin + B-lactamase inhibitors

A

1) Amoxicillin + Clavulonic acid (Augmentin) (PO)

2) Piperacillin + Tazobactam (IV)

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26
Q

T/F: Penicillin + B-lactamase inhibitors work very well to treat all anaerobes

A

TRUE

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27
Q

Penicillins ADRs

A

1) Allergic rxn - anaphylaxis, rash, urticaria, fever
2) Diarrhea
3) Hematologic - anemia, thrombocytopenia
4) Hepatitis (nafcillin, oxacillin)
5) Interstitial nephritis (nafcillin, oxacillin)
6) Seizures
7) Renal failure

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28
Q

If pt. have a true Penicillin allergy, there is a 5% cross reactivity with _____________

A

cephalosporins

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29
Q

Amoxicillin + Clavulanate (Augmentin) s/e

A

-notable GI s/e (diarrhea is very common)

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30
Q

What is the most severe cause of antibiotic induced diarrhea?

A

Pseudomembranous colitis (C. diff colitis)

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31
Q

Most penicillins are renally cleared so you have to adjust dosage for renal fn changes. What are the exceptions?

A

Nafcillin, oxacillin, dicloxacillin

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32
Q

What natural product does amoxicillin have a major interaction with?

A

Acacia

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33
Q

Cephalosporins MOA

A

disturbs cell wall synthesis of bacteria

B-lactam binds PBPs

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34
Q

T/F: Cephalosporins not, ever cover enterococcus

A

TRUE

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35
Q

Cephalexin (Keflex) (PO) and Cafazolin (IV) class

A

1st generation cephalosporins

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36
Q

Cephalexin (Keflex) (PO) and Cafazolin (IV) spectrum

1st gen

A

1) Gram pos = Strep and MSSA
2) Gram neg = some E.coli and Kleb
3) oral anaerobes

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37
Q

Cephalexin (Keflex) (PO) and Cafazolin (IV) indications

1st gen

A

UTIs, skin infx, some respiratory infx, surgical prophylaxis

*alternative to penicillins in allergic pt.

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38
Q

Cefuroxime, cefotetan, cefoxitin class

A

2nd generation cephalosporins

more resistant to beta-lactamase activity than 1st gen

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39
Q

Cefuroxime, cefotetan, cefoxitin spectrum

2nd gen

A

1) Gram pos = Strep, MSSA
2) Gram neg = good coverage
3) Anaerobes = oral and B. fragilis (cefoxitin, cefotetan)

*None are effective against pseudomonas

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40
Q

Ceftriaxone (IV), cefotaxime,ceftazidime, cefixime class

A

3rd generation cephalosporins

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41
Q

Ceftriaxone (IV), cefotaxime,ceftazidime, cefixime spectrum

3rd gen

A

1) Gram pos = Strep, MSSA
2) Gram neg = very good; P. aeruginosa (Ceftazidime)
3) oral anaerobes

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42
Q

Ceftriaxone (IV), cefotaxime,ceftazidime, cefixime indications

(3rd gen)

A
  • respiratory infx
  • serious infx
  • some are able to cross BBB
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43
Q

Cefuroxime, cefotetan, cefoxitin indications

2nd gen

A 
some respiratory (oral)
GI infx (B. fragilis)
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44
Q

Cefepime (IV) class

A

4th generation cephalosporins

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45
Q

Cefepime indications

4th gen

A

serious hospital infx

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46
Q

Cefepime spectrum

4th gen

A

1) Gram pos = Strep, MSSA
2) Gram neg = Excellent; P. aeruginosa
3) Oral anaerobes

47
Q

What is the only cephalosporin that can tx B. fragilis?

A

Cefoxitin (2nd gen)

48
Q

Which cephalosporin(s) can tx Pseudomonas?

A

Ceftazidime (3rd gen)

Cefepime (4th gen)

49
Q

What is the newly approved ‘5th generation’ cephalosporin and what can it tx?

A

Ceftaroline

Tx: MRSA (the only one), Strep. pneumo, GNR

Does NOT tx pseudomonas

50
Q

Most cephalosporins are renally cleared and doses need to be adjusted for renal function changes. An exception to this is _______

A

ceftriaxone (3rd gen)

51
Q

Cephalosporin ADRs

A

1) Allergic - anaphylaxis, rash, urticaria, fever; 3-7% cross resistance with PCN allergy
2) Diarrhea

3) Hematologic - anemia, thrombocytopenia
4) Seizures (high doses)

52
Q

Macrolides MOA

A

inhibition of bacterial protein synthesis by binding to the 50s subunit

mostly bacteriostatic

53
Q

Macrolides resistance

A

plasmid mediated changes or inactivation of ribosomal response

54
Q

Erythromycin, Azithromycin, and Clarithromycin class

A

Macrolides

55
Q

Erythromycin, Azithromycin, and Clarithromycin (i.e. Macrolides) spectrum

A

1) Gram pos = Strep, pneumococci, Mb MSSA
2) Gram neg = minimal (H. flu)
3) oral anaerobes
4) Atypical respiratory pathogens (legionella, chlamydia, mycoplasma)

56
Q

Which class of antibiotics do well at tx atypical respiratory pathogens such as Legionella sp., Chlamydia pneumoniae, and Mycoplasma pneumonia?

A

Macrolides**
Tetracyclines
Fluoroquinolones

57
Q

Erythromycin, Azithromycin, and Clarithromycin (macrolides) ADRs

A

1) GI - N/V, diarrhea (Erythro > clarithro > azithro)
2) Phlebitis (IV erythro)
3) Prolonged QT interval (Erythro > clarithro&raquo_space; azithro)
4) Hepatotoxicity (erythro)

58
Q

Macrolides have multiple drug interactions because they

A

inhibit liver CYP3A4

Erythro&raquo_space; clarithro&raquo_space; azithro

59
Q

Tetracyclines MOA

A

inhibits protein synthesis by binding to the 30s ribosomal subunit

bacteriostatic

60
Q

Tetracyclines spectrum

A

1) Gram pos = Strep, MSSA (SSTI)
2) Gram neg = H. flu, rickettsiae; other gram neg often resistant
3) mostly oral anaerobes
4) atypical respiratory pathogens (Legionella, chlamydia, mycoplasma)

61
Q

Tetracyclines ADRs

A

1) **Photosensitivity
2) nausea and diarrhea
3) **tooth discoloration in children (C/I in children and pregnancy)
4) esophagitis
5) leukocytosis

62
Q

Macrolides natural product interactions

A

cesium, ephedra, oleander, sida cordifolia

63
Q

Tetracyclines natural product interactions

A

oleander, hypericum, p-glycoprotein substrates

64
Q

T/F: tetracyclines are more effective when given with calcium supplements or dairy products

A

FALSE

they should NOT be given with Ca++ or dairy products

65
Q

Sulfonamides (Sulfa Drugs) MOA

A

inhibits folic acid synthesis via enzyme inhibition

bacteriostatic

66
Q

Sulfamethoxazole with Trimethoprim/Bactrim MOA

A

synergistically inhibits two steps in folic acid synthesis

67
Q

Sulfamethoxazole with Trimethoprim/Bactrim spectrum

A

1) Gram pos = Strep, MSSA, CAMRSA
2) Gram neg = most enterobacteriacae
3) Oral anaerobes

68
Q

T/F: Sulfamethoxazole with Trimethoprim/Bactrim can treat community acquired MRSA

A

TRUE

69
Q

Bactrim ADRs

A

1) Allergic rxn (sulfonamide moiety) - rash, fever, photosensitivity, urticaria
2) GI effects
3) Neutropenia, thrombocytopenia (folate deficiency)
4) Steven Johnsons Syndrome (rare)

70
Q

Bactrim increases effects of which drug?

A

warfarin

71
Q

Fluoroquinolones MOA

A

inhibit bacterial DNA gyrase, inhibiting DNA replication and transcription

***Bactericidal

72
Q

Levofloxacin, Ciprofloxacin, and Moxifloxacin class

A

Fluoroquinolones

73
Q

Fluoroquinolones spectrum

A

potent broad-spectrum that can tx most gram neg and some gram pos

1) gram pos = Strep, MSSA (cipro poor)
2) gram neg = majority, P. aerugonisa
3) minimal anaerobes
4) atypical respiratory pathogens (CA pneumonia - legionella, chlamydia, mycoplasma)

74
Q

Fluoroquinolones ADRs

A

1) GI - nausea
2) CNS - HA, dizziness, insomnia, confusion, seizures; esp. in elderly
3) Cartilage toxicity (C/I children and pregnancy)
4) Prolonged cardia QT interval

75
Q

Levofloxacin (Fluoroquinolone) natural product interactions

A

1) cesium
2) ephedra
3) grapefruit
4) sida cordifolia
5) sweet orange

76
Q

What are our main anti-anaerobe drugs?

A

Metronidazole and Clindamycin

77
Q

Metronidazole (Flagyl) MOA

A

inhibiting nucleic acid synthesis

78
Q

Clindamycin MOA

A

ribosomal protein synthesis inhibitor

79
Q

Metronidazole (Flagyl) spectrum

A

ONLY ANAEROBES!

80
Q

Which antibiotic tx C. diff associated diarrhea and intra-abdominal abscess?

A

Metronidazole (Flagyl)

81
Q

Clindamycin spectrum

A

1) Gram pos = Step, MSSA, Mb CAMRSA
2) Gram neg = none**
3) Good coverage for anaerobes (o.k. B. fragilis)

82
Q

Metronidazole (Flagyl) ADRs

A

1) GI - nausea, diarrhea
2) metallic taste
3) “Disulfiram rxn” - flushing, sweating, nausea w/ alcohol; can persist for a few days post drug

83
Q

Clindamycin ADRs

A

1) GI - Diarrhea, nausea, C. diff

84
Q

Nitrofurantoin (Macrobid) indication

A

lower UTI

  • *not for pyelonephritis
  • considered safe in pregnancy prior to 38 wks of gestation
85
Q

Nitrofurantoin (Macrobid) MOA

A

disrupts both DNA and RNA of bacteria which are sensitive to the drug

86
Q

Nitrofurantoin (Macrobid) ADRs

A

1) GI - N/V, diarrhea
2) fever and chills (LC)
3) pulmonary fibrosis (LC)

87
Q

Gentamicin, Tobramycin, and Amikacin class

A

Aminoglycosides

88
Q

when would you use aminoglycosides?

A

severe infections caused by gram negative, pseudomona auerginosa

89
Q

aminoglycosides ADRs

A

nephrotoxicity and ototoxicity (monitoring required)

only use in hospital severe infx

90
Q

What is the primary drug used to treat MRSA?

A

IV Vancomycin

91
Q

What is the ‘triple antibiotic cream’

A

Neosporin OTC

Bacitracin + Neomycin + Polymyxin B

92
Q

T/F: Most pharyngitis cases are bacterial

A

FALSE

90% of cases are viral (however, about 60% of OV result in antibiotic rx)

93
Q

MC bacterial cz of pharyngitis

A

Group A B-hemolytic streptococci (GABHS)

*S. pyogenes

94
Q

DOC to tx GABHS

A

penicillin

if PCN allergy/resistance, tx w/ azithromycin or cephalosporins

95
Q

What is the leading indication for outpatient antimicrobial use in the U.S.?

A

otitis media

25-50% are viral in origin, however, 80% are rx antibiotics

96
Q

MC bacterial etiologies of otitis media

A

1) Step. pneumo (~35%)
2) Haemophilus influenzae (~25%)
3) Moraxella catarrhalis (~15%)

97
Q

guidelines state that it is appropriate to observe pt. with otitis media in children 2-12 y/o with non-severe symptoms for ______ hours

A

48-72 hrs (or start if child worsens)

**70-90% of children have spontaneous resolution with 7-14 days

98
Q

T/F: if child has AOM with otorrhea you should not observe and go right to tx with antibiotics

A

TRUE

99
Q

DOC for otitis media

A 
#1 Amoxicillin 
#2 Amoxicillin-clavulante (2nd line used for more gram neg)

(alternative for PCN allergy or tx failure are Cephalosporins, Macrolides, and Clindamycin)

100
Q

Treatment failure with otitis media is defined as

A

no improvement after 48-72 hours of initial tx (switch drugs!)

101
Q

T/F: Purulent nasal secretions or sputum do not predict bacterial infection

A

TRUE

102
Q

____% of sinusitis cases are viral and ____% of sinusitis cases are bacterial

A

25% viral

75% bacterial

103
Q

What are the MC bacterial cz of sinusitis?

A

S. pneumoniae, H. influenza, and M. catarrhalis

104
Q

First-line tx for sinusitis

A
  • amoxicillin
  • doxycycline
  • TMP/SMX
105
Q

Second-line tx for sinusitis

A
  • amoxicillin/clavulanate
  • cephalosporins
  • azithromycin or clarithromycin
106
Q

MC bacteria involved in community-acquired pneumonia

A

S. pneumoniae

H. influenzae

107
Q

For pt. with CA pneumonia that were previously healthy have not use of antimicrobials w/in past 3 mo., tx with

A
  • a macrolide (strongly recommended)
  • doxycyline (weakly recommended)

*risk of resistance to S. pneumo is high for these drugs

108
Q

MC bacterial cz of uncomplicated cystitis

A

1) E. coli (75-95% cases)
2) Klebsiella pneumonia
3) Staph. saprophyticus (post-coital UTIs)
4) Enterococcus
5) Strep. agalactiae (group B strep)

109
Q

If Enterococcus is expected as causative organism in uncomplicated cystitis, tx with

A

Amoxicillin
Ampicillin

(otherwise avoid these drugs)

110
Q

Tx for Gonorrhea

A

Single dose tx of:
1) Ceftriaxone 250 mg IM x 1

PLUS

2) Azithromycin 1g PO x 1

(fluoroquinolones are no longer used d/t resistance)

111
Q

Tx for Chlamydia trachomatis

A

1) Doxycycline 100 mg po BID x 7 days

OR

2) Azithromycin 1 g po x1 (used in tx of gonorrhea anyway)

112
Q

Mild-cellulitis is most often d/t

A

Group A Strep or Staph aureus (MSSA)

113
Q

Cellulitis that is uncomplicated & non-MRSA infx can be tx with

A

1) Amoxil-clavulanate
2) Dicloxacillin
3) Cephalexin

114
Q

Cellulitis with a suspicion of MRSA infx requires empiric tx with

A

1) TMP-sulfa
2) Clindamycin
3) Doxycycline

Pharmacology (14 decks)

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