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Antibiotics Flashcards

1
Q

Types of antibiotics

A

1 bactericidal

2. Bacteriostatic

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2
Q

Bactericidal antibiotics

A 
Vancomycin
Fluoroquinolones
Penicillins
Aminoglycosides
Metronidazole

Very Finely Proficient at Murder

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3
Q

Bacteriostatic antibiotics

A 
Erythromycin
Clindamycin
Sulfamethoxazole
Trimethoprim
Tetracycline
Chloramphenicol

ECSTaTiC

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4
Q

natural penicillin
narrow spectrum
for streptococcal, pneumococcal, meningococcal infections, syphilis
SE: hypersensitivity, GI disturbances, seizures
RENAL TUBULAR REABSORPTION INHIBITED BY PROBENECID
INACTIVATED BY BETA-LACTAMASE (PENICILLINASE)

A 
Penicillin G (parenteral)
Penicillin V (oral)
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5
Q

isoxazolyl penicillin (anti-staphylococcal)
very narrow spectrum
for STAPHYLOCOCCAL INFECTIONS
SE: hypersensitivity, cross allergenicity with other penicillins, GI disturbances, INTERSTITIAL NEPHRITIS, NEUTROPENIA
RESISTANT TO INACTIVATION BY BETA-LACTAMASE (PENICILLINASE)

A

methicillin (interstitial nephritis)

nafcillin (neutropenia), oxacillin, cloxacillin, dicloxacillin

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6
Q 
amino penicillin
extended spectrum
for HELPSE infections
SE: PSEUDOMEMBRANOUS COLITIS, rash
INACTIVATED BY BETA-LACTAMASE
ENHANCED EFFECT WHEN USED WITH BETA-LACTAMASE INHIBITORS (CLAVULANIC ACID, SULBACTAM)
SYNERGISTIC EFFECT WITH GLYCOSIDES
A

Ampicillin (IV)

Amoxicillin (oral)

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7
Q

anti-pseudomonal penicillin
SE: hypersensitivity, cross-allergenicity, GI disturbances,
INACTIVATED BY BETA-LACTAMASE
ENHANCED EFFECT WHEN USED WITH BETA-LACTAMASE INHIBITORS (CLAVULANIC ACID, SULBACTAM)
SYNERGISTIC EFFECT WITH GLYCOSIDES AGAINST PSEUDOMONAS

A

Piperacillin

Ticarcillin, Carbenicillin

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8
Q

Beta-Lactamase RESISTANT drugs

A
  1. 4th generation cephalosporins
  2. monobactam (aztreonam)
  3. isox. benz.
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9
Q

1st gen cephalosporin
gram + coverage
for SURGICAL PROPHYLAXIS, BONE INFECTIONS
SE: hypersensitivity
INCREASES nephrotoxicity of aminoglycosides

A

cefazolin

cefadroxil, cephalexin, cephalothin, cephapirin, cephradine

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10
Q

which microbes are covered by spectrum of activity of 1st gen cephalosporins?

A

PEcKs FIRST

Proteus mirabilis
E. Coli
Klebsiella pneumoniae

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11
Q

2nd gen cephalosporin
addded coverage for Haemophilus, Enterobacter, and Neisseria
SE: hypersensitivity, DISULFIRAM REACTION
INCREASES nephrotoxicity of aminoglycosides

A

cefaclor
cefamandole, cefmetazole, cefonicid, cefuroxime, cefprozil, ceforanide, cefoxitin, cefotetan, loracarbef

DISULFIRAM REACTION: cefamandole, cefotetan

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12
Q

3rd gen cephalosporin
SE: hypersensitivity
SYNERGISTIC EFFECT WITH AMINOGLYCOSIDES

A

cefoperazone
cefotaxime, ceftazidime, ceftizoxime, ceftriaxone, cefixime, cefpodoxime proxetil, cefdinir, cefditoren pivoxil, ceftibuten, moxalactam

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13
Q 
4th gen cephalosporin
wide coverage against gram + and gram - bacteria, MRSA
SE: hypersensitvity
RESISTANT TO BETA-LACTAMASE
BROAD GRAM NEG ACTIVITY
A

cefepime

ceftaroline

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14
Q

carbapanem
wide coverage against gram + and gram - bacteria
SE: hypersensitvity, CNS toxicity (confusion, encephalopathy, SEIZURES)
for SERIOUS LIFE THREATENING INFECTIONS

A

Imipinem-Cilastatin
Ertapenem, Meropenem, Doripenem

Cilastatin inhibits renal metabolism
Hydrolysis of imipenem by dihydropeptidase

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15
Q 
monobactam
for GRAM NEG RODS
RESISTANT TO BETA LACTAMASE
NO CROSS-ALLERGENICITY WITH PENICILLINS
NO ACTIVITY AGAINST GRAM POSITIVE BACTERIA OR ANAEROBES
A

aztreonam

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16
Q

anti-pseudomonal cephalosporins

A

ceftazidime
cefepime
cefoperazone

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17
Q

beta-lactamase inhibitor
SE: hypersensitivity
usually combined with amoxicillin, ampicillin, piperacillin

A

clavulanic acid

sulbactam, tazobactam

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18
Q 
glycopeptide
binds to D-Ala-D-Ala
for MRSA, PSEUDOMEMBRANOUS COLITIS
SE: Red Man Syndrome, Nephrotoxicity, Ototoxicity
for SERIOUS LIFE-THREATENING INFECTIONS
A

vancomycin

teicoplanin, dalbavancin, telavancin

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19
Q

treatment for Red Man Syndrome

A

slowing rate of infusion

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20
Q

drugs of last resort

A 
Imipinem
Amikacin
Meropenem
Linezolid
Streptogramins
Vancomycin
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21
Q

peptide antibiotic
SE: nephrotoxicity
for TOPICAL USE ONLY DUE TO MARKED NEPHROTOXICITY

A

bacitracin

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22
Q

blocks incorporation of D-Ala into pentapeptide
for DRUG-RESISTANT TB (2ND LINE DRUG)
SE: NEUROTOXICITY (TREMORS, SEIZURES, PSYCHOSIS)

A

cycloserine

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23
Q

binds to cell membrane causing depolarisation and rapid cell death
for gram + infections (sepsis, endocarditis)
SE: myopathy
inactivated by pulmonary surfactants

A

daptomycin

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24
Q

inactivates enzyme UDP-acetylglycosamine-3-enolpyruvyltransferase
for uncomplicated UTI
SAFE FOR PREGNANT PATIENTS

A

fosfomycin

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25
bacterial protein synthesis inhibitors
30s Aminoglycosides Tetracyclines ``` 50s Chloramphenicol Erythromycin (macrolides) Linezolid Lincosamides (clindamycin) Streptogramins ```
26
broad spectrum bacterial protein synthesis inhibitor binds 50s subunit BACTERIOSTATIC for MENINGITIS SE: APLASTIC ANEMIA, GRAY BABY SYNDROME inhibits hepatic drug-metabolising enzymes causing many drug interactions
chloramphenicol
27
moderate spectrum bacterial protein synthesis inhibitor macrolide binds 50s subunit BACTERIOSTATIC SE: cholestatic hepatitis, hepatotoxicity, QT prolongation, drug interactions
erythromycin (alternative for penicillin allergic patients) azithromycin (highest Vd and slowest elimination) clarithromycin telithromycin (used for macrolide resistance)
28
ALL macrolides inhibit CYP450 enzymes EXCEPT for
azithromycin
29
broad spectrum bacterial protein synthesis inhibitor tetracycline binds 30s subunit BACTERIOSTATIC for atypical infections (M. pneumoniae, chlamydiae, rickettsiae, and Vibrio) SE: tooth enamel dysplasia/discoloration, photosensitivity
tetracycline | doxycycline, minocycline (vestibulotoxicity) tigecyline (broadest spectrum and least resistance), demeclocycline
30
narrow spectrum bacterial protein synthesis inhibitor lincosamide binds 50s subunit BACTERIOSTATIC for ANAEROBIC INFECTIONS SE: PSEUDOMEMBRANOUS COLITIS (C. difficile overgrowth)
clindamycin lincomycin cross-resistance between clindamycin and macrolides is common
31
narrow spectrum bacterial protein synthesis inhibitor streptogramin binds 50s subunit BACTERICIDAL for MRSA, VRSA, VRE SE: arthralgia-myalgia syndrome INHIBITS CYP450 ENZYMES causing multiple drug interactions
quinupristin-dalfopristin
32
``` narrow spectrum bacterial protein synthesis inhibitor oxazolidinone binds to 23s of 50s subunit BACTERIOSTATIC for MRSA, VRSA, VRE ```
linezolid
33
post-antibiotic effect of aminoglycosides
killing action continues when plasma levels have declined below measurable levels greater efficacy when administered as single large dose
34
pharmacokinetics of aminoglycosides
not absorbed after oral administration limited tissue perfusion glomerular filtration is major mode of excretion
35
aminoglycoside binds to 30s subunit BACTERICIDAL SE: nephrotoxicity (reversible), ototoxicity (irreversible) synergistic effects with beta-lactam antibiotics and vancomycin
gentamicin tobramycin most vestibulotoxic and nephrotoxic aminoglycosides
36
aminoglycoside binds to 30s subunit BACTERICIDAL for PSEUDOMONAS, MDR-TB (2ND LINE DRUG) SE: nephrotoxicity (reversible), ototoxicity (irreversible) synergistic effects with beta-lactam antibiotics LEAST RESISTANCE BUT NARROWEST THERAPEUTIC WINDOW
amikacin
37
``` aminoglycoside binds to 30s subunit BACTERICIDAL for TB SE: nephrotoxicity (reversible), ototoxicity (irreversible), CONGENITAL DEAFNESS synergistic with beta-lactam antibiotics administered IM ```
streptomycin
38
aminoglycoside binds to 30s subunit BACTERICIDAL for BOWEL PREP FOR ELECTIVE SURGERY, HEPATIC ENCEPHALOPATHY SE: nephrotoxicity (reversible), ototoxicity (irreversible), NEUROMUSCULAR BLOCKADE limited to TOPICAL AND ORAL USE
neomycin | kanamycin (most ototoxic), paromomycin
39
reverses neuromuscular blockade sec to aminoglycosides
gluconate and neostigmine
40
most ototoxic aminoglycosides
kanamycin, amikacin
41
most vestibulotoxic aminoglycosides
tobramycin, gentamicin
42
most nephrotoxic aminoglycosides
tobramycin, gentamicin
43
skin reactions common with which aminoglycosides
neomycin and streptomycin
44
nucleic acid synthesis inhibitors anti-folate sulfonamide BACTERIOSTATIC for BURN INFECTIONS SE: ACUTE HEMOLYSIS IN G6PD DEFICIENCY, HYPERSENSITIVITY, KERNICTERUS displaces protein blinding of other drugs/bilirubin
silver sulfadiazine | mafenide acetate
45
nucleic acid synthesis inhibitors anti-folate sulfonamide BACTERICIDAL seuqential BLOCKADE OF DIHYDROFOLATE SYNTHASE & REDUCTASE for UTI, PCP SE: ACUTE HEMOLYSIS IN G6PD DEFICIENCY, HYPERSENSITIVITY, KERNICTERUS displaces protein blinding of other drugs/bilirubin
co-trimoxazole
46
antibiotic for anaerobic infections above diaphragm vs. below diaphragm
clindamycin: above diaphragm metronidazole: below diaphragm
47
long-acting sulfonamide
sulfadoxine
48
DOC for toxoplasmosis | 2nd line for malaria
sulfadoxine-pyrimethamine
49
co-administered with leucovorin to limit bone marrow toxicity
pyrimethamine
50
aminoglycoside binds to 30s subunit BACTERICIDAL for DRUG RESISTANT GONORRHEA, GONORRHEA IN PENICILLIN-ALLERGIC PATIENTS SE: nephrotoxicity (reversible), ototoxicity (Irreversibl), anemia
spectinomycin
51
generation of fluoroquinolones that is NOT fluorinated
1st gen: for UTI nalidixic acid, cinoxacin, rosoxacin, oxolinic acid
52
2nd gen fluoroquinolone inhibits DNA replication BACTERICIDAL for UTI, ATYPICAL PNEUMONIA, TB (2ND LINE DRUG) SE: GI DISTRESS, TENDONITIS, TENDON RUPTURE AVOID USING IN YOUNG CHILDREN & PREGNANT WOMEN (chelates Ca)
ciprofloxacin | ofloxacin, norfloxacin, lomefloxacin, enoxacin
53
DOC for UTI
ciprofloxacin
54
3rd gen fluoroquinolone inhibits DNA replication BACTERICIDAL for LUNG INFECTIONS by gram + cocci, ATYPICAL PNEUMONIA SE: GI distress, TENDINITIS, QT PROLONGATION AVOID USING IN YOUNG CHILDREN & PREGNANT WOMEN
levofloxacin sparfloxacin, moxifloxacin, gemifloxacin enhances toxicity of methylxanthines (theophylline) grepafloxacin withdrawn due to severe cardiotoxicity (arrhythmias) gatifloxacin SE: DM
55
4th gen fluoroquinolone inhibits DNA replication BACTERICIDAL ENHANCED ACTIVITY AGAINST ANAEROBES SE: GI distress, TENDINITIS, QTc prolongation, hepatotoxicity AVOID USING IN YOUNG CHILDREN & PREGNANT WOMEN enhances toxicity of methylxanthines (theophylline) WIDEST SPECTRUM OF ACTIVITY AMONG FLUOROQUINOLONES
trovafloxacin | alatrofloxacin
56
nitroimidazole, anti-protozoal reactive reduction by ferredoxin FORMING FREE RADICALS THAT DISRUPT ETC BACTERICIDAL for ANAEROBIC infections, VAGINITIS, PSEUDOMEMBRANOUS COLITIS SE: GI irritation, metallic taste, DISULFIRAM REACTION
metromidazole | tinidazole
57
disrupts protein, RNA, DNA synthesis BACTERICIDAL for UNCOMPLICATED UTI (except PROTEUS and PSEUDOMONAS) SE: skin rashes, PULMONARY FIBROSIS & INFILTRATES
nitrofurantoin
58
topical anti-infective pseudomonic acid BACTERICIDAL for GRAM + COCCI, minor skin infections
mupirocin
59
``` cationic detergents BACTERICIDAL for GRAM - bacteria proteus and neisseria resistant TOPICAL USE ONLY ```
polymyxin B | polymyxin E
60
``` macrocyclic, narrow spectrum inhibits bacterial protein synthesis BACTERIOSTATIC GRAM + bacteria ORPHAN DRUG STATUS FOR C. DIFFICILE IN CHILDREN ```
fidaxomicin

Pharmacology (31 decks)

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