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Clinical Therapeutics > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

How would you dose a time-dependent killing drug?

A

Dose it often, has a minimal post-antibiotic effect

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2
Q

How would you dose a concentration-dependent killing drug?

A

Increase the dose all at once

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3
Q

Examples of time-dependent drugs

A

All B-lactam agents

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4
Q

Examples of concentration-dependent drugs

A

Aminoglycosides and Fluoroquinolones

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5
Q

What does synergistic drug effects mean?

A

Antibiotics given together that enhance the efficacy of a drug

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6
Q

Example of synergistic drug

A

Sulfamethoxazole/Trimethoprim (Bactrim)

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7
Q

What are the two PCN resistance methods?

A
  1. B-lactamase enzymes inactivate the antibiotic

2. Modification of the target PBP/ low or decreased affinity for Penicillin binding protein

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8
Q

Which organisms typically are effected with beta-lactamase enzymes?

A

Gram - organisms and staph aureus

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9
Q

How do you overcome the b-lactamase enzymes?

A

Co-formulate with b-lactam inhibitors

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10
Q

How do you overcome the extended spectrum beta-lactamase (ESBL)?

A

Give Carbapenems

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11
Q

How to overcome resistance when the PBP site is changed

A

Switch to an agent covering MRSA, or give high dose drugs (amoxicillin as example)

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12
Q

If you have a MRSA or strep pneumoniae resistance what do you do?

A

Change antibiotics

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13
Q

What are the two antibiotics in the NPCN class?

A 
PCN G (IV)
PCN VK (PO)
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14
Q

What do the natural penicillins cover?

A

Strep, VSE, Anaerobe (Peptostreptococcus)

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15
Q

What is a common indication for the NPCNs?

A

Dental infections, throat infections

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16
Q

What are the examples of Penicillinase resistant antibiotics?

A

Nafcillin (IV)
Oxacillin (IV)
Dicloxacillin (PO)

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17
Q

What do the penicillinase resistants cover?

A

MSSA (GREAT), Strep

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18
Q

What is a common indication for the penicillinase resistants?

A

Skin infections, MSSA infections including endocarditis

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19
Q

What are the examples of AminoPCNs?

A

Ampicillin (IV)

Amoxicillin (PO)

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20
Q

What do the AminoPCNs cover?

A

Strep, VSE, Anaerobes (Peptostreptococcus), +/- GNR, +/- H.flu M.Catarral

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21
Q

What are common indications for the AminoPCNs?

A

Otitis media, UTIs/URIs
Meningitis (Ampicillin)
Listeria (Ampicillin GOLD STANDARD)

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22
Q

What are the example of the Amino+BLIs?

A

Augmentin (Clavulanic acid, PO)

Unasyn (Sulbactam, IV)

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23
Q

What do the Amino+BLIs cover?

A

MSSA, Strep, VSE, Anaerobe (pepto), GNR, H.flu M.catarral, GN Anaerobe (bacteroides)
EVERYTHING EXCEPT PSEUDO MRSA and ATYPICALS

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24
Q

What are common indications for the Amino+BLIs?

A

Human bites, animal bites (Augmentin)

Broad empiric coverage, H-A infections, B-lactamase producing organisms

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25
Q

What is the antipseudomonal?

A

Piperacillin-Tazobactam (Zosyn) IV

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26
Q

What does Zosyn cover?

A

Everything except MRSA and ATYPICALS

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27
Q

What is the gold standard for PCN sensitive enterococcus?

A

Ampicillin

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28
Q

What else can Unasyn cover?

A

Acinetobacter

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29
Q

What can you do for a Strep pneumoniae resistance for Otitis media?

A

Can give high dose Amoxicillin, then change class if still not working

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30
Q

Which drugs are in the 1st generation cephalosporins?

A

Cefazolin (IV)
Cephalexin (PO)
Cephadroxil (PO)

31
Q

What do the 1st generation cephalosporins cover?

A

MSSA, Strep, GP Anaerobe (pepto), +/-GNR

32
Q

What are some common indications for the 1st gen cephalosporins?

A

2nd line for MSSA, SSTIs, UTI, Pre-op Abx

33
Q

Which drugs are in the 2nd generation cephalosporins?

A

Cefoxitin (IV considered abd)
Cefotetan
Cefuroxime (IV considered resp)
Cefprozil

34
Q

What do the 2nd gen cephalosporins cover?

A

MSSA, Strep, GP Anaerobe (pepto), GNR, +/-HNM

35
Q

What does Cefoxitin cover that Cefuroxime does not? (2nd gens)

A

+/- coverage for GN Anaerobe Bacteroides Fragilis

36
Q

What are the common indications for 2nd gen cephalosporins?

A

Respiratory tract infections, abdominal infections, GYN infections

37
Q

Which drugs are in the 3rd gen cephalosporins?

A

Ceftriaxone IV Cepodoime PO

Ceftazadime (IV)

38
Q

What is the coverage for 3rd gen cephalosporins?

A

MSSA, Strep, GP Anaerobe (pepto), GNR, HNM

39
Q

What else does Ceftazadime cover that Ceftriaxone does not (3rd gen)?

A

+/- MSSA, also covers pseudomonas

40
Q

What is the 4th gen cephalosporin?

A

Cefepime (IV)

41
Q

What does Cefepime (IV) cover?

A

MSSA, Strep, GP Anaerobe (pepto), GNR, HNM, Pseudomonas

42
Q

What is a common indication for 3rd gen cephalosporin?

A

CAP, meningitis, lyme
Gonorrhea: Ceftriaxone
Hospital acquired pneumonia: Ceftazadime

43
Q

What is a common indication for Cefepime (IV)?

A

Hospital-acquired infections, neutropenic fever

44
Q

What is the 5th gen cephalosporin?

A

Ceftaroline (IV)

45
Q

What does Ceftaroline (Iv) cover?

A

MSSA, Strep, GP Anaerobe (pepto), GNR, HNM, MRSA

46
Q

What is a common indication for Ceftaroline (IV)?

A

Skin and sin structure infections, MRSA and VSA infections

47
Q

Do cephalosporins cover enterococcus (VSE) infections?

A

NO

48
Q

Which 2nd gens are used for respiratory infections?

A

Cefuroxime, Cefaclor, Cefprozil

49
Q

Which 2nd gens are used for abdominal/GYN infections?

A

Cefoxitin, Cefotetan

50
Q

What are the 4 fluoroquinolones?

A

Ciprofloxacin, Levofloxacin, Moxifloxacin, Ofloxacin

51
Q

What is the spectrum for fluoroquinolones?

A

Excellent atypical coverage (chlamydia, legionella, mycoplasma)

52
Q

What are the common indications for fluoroquinolones?

A

Respiratory tract infections (except cipro)
UTIs (except moxi)
Intra-abdominal infections, osteomyelitis

53
Q

What does Ciprofloxacin cover?

A

+/-MSSA and Strep, GNR, HNM, Pseudomonas, ATYPICALS

54
Q

What does Levofloxacin cover?

A

MSSA, Strep, GP Anaerobe (pepto), GNR, HNM, Pseudomonas, ATYPICALS

55
Q

What does Moxifloxacin cover?

A

MSSA, Strep, GP Anaerobe (pepto), GNR, HNM, +/- Bacteroides, ATYPICALS

56
Q

What are carbapenems also called?

A

Gorilla-cillins

57
Q

What are carbapenems the DOC for?

A

Ceftriaxone-resistant E.coli, Klebsiella, P.mirabilis (ESBL), complicated UTI, intra-abdominal infections

58
Q

What are the 4 carbapenems? (IV only)

A

Impenem/cilastatin (Primaxin)
Meropenem (Merrem)
Doripenem (Doribax)
Ertapenem (Invanz)

59
Q

What is the coverage for carbapenems?

A

MSSA, Strep, GP Anaerobe (pepto), GNR (entero), HNM, Pseudomonas (except Ertapenem), GN Anaerobe (B.fragilis)

60
Q

What is an important ADR about carbapenems?

A

Higher risk of seizures with imipenem at high doses

61
Q

What does Monobactam cover? (Aztreonam IV)

A

GNR and respiratory organisms and pseudomonas

62
Q

What do you do if pt has anaphylaxis to beta-lactams?

A

Switch to a different class of antibiotics

63
Q

What do you do if pt has a rash to a PCN?

A

Can consider a cephalosporin w/decreasing levels of cross reactivity or carbapenem

64
Q

Can you use aztreonam if pt has a rash to PCN?

A

Yes, unless Ceftazidime allergy

65
Q

What are important ADRs associated with fluoroquinolones?

A

Cant give to pregnant or children, FDA BBW for tendonopathies especially in elderly and children, prolongs Cumadin levels

66
Q

What are the Macrolides?

A

Erythromycin, Clarithromycin, Azithromycin

67
Q

What is the coverage for macrolides?

A

+/- MSSA Strep and GP Anaerobes, HNM, Atypicals

Cover for respiratory Gram -s

68
Q

What are the common indications for macrolides?

A

Respiratory tract infections, alternative for PCN-allery (otitis media, pharyngitis), Chlamydia, Travelers diarrhea

69
Q

What is important to note about macrolides?

A

NOT used for sepsis, urine or soft tissue infections!! Cause QTc prolongation

70
Q

What are the tetracyclines?

A

Doxycycline, Tetracycline, Minocycline, Tigecycline

71
Q

What are the common indications for tetracyclines?

A

Respiratory tract infections, MRSA skin and soft tissue infections, Tick-borne infections

72
Q

What are some ADRs with tetracyclines?

A

Not indicated for children less than 8 or pregnancy. Cause tooth discoloration, GI esophagitis, photosensitivity

73
Q

What is the coverage for tetracyclines?

A

MSSA, MRSA, +/- Strep, GP Anaerobes, HNM, Atypicals

74
Q

What else does Tigecycline (IV) cover that other tetracyclines do not?

A

GNR, B.fragilis

Clinical Therapeutics (8 decks)

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