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Pharmacology > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

What are beta-lactams?

A

a group of antibiotics that include a beta-lactam ring.

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2
Q

What are the 4 groups of beta-lactams?

A
  1. penicillins
  2. cephalosporins
  3. Carbapenems
  4. Monobactams
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3
Q

What is the mechanism of action of beta-lactams?

A

They bind to PBPs (penicillin binding proteins) which are the final step of petidoglycan synthesis in bacterial cell walls so lysis occurs leading to death of the bacterial cell (bactericidal)

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4
Q

What are the subclasses of penicillins?

A

Natural penicillins, penicillinase-resistant penicillins, aminopenicillins and penicillin + beta-lactamase inhibitor

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5
Q

Natural penicillins include

A 
Aqueous Crystalline penicillin G (IV)
Penicillin VK (PO)
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6
Q

Natrual penicillin spectrum

A

Gram-pos
anaerobes
treponema pallidum (causes syphilis)

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7
Q

Penicillinase-resistant penicillins include

A

Nafcillin (IV) - for MSSA

Dicloxacilin (PO)

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8
Q

Penicillinase-resistant penicillin spectrum

A

staphylococcus (MSSA)

streptococcus

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9
Q

Aminopenicillins include

A

Ampicillin (IV and PO)

Amoxicillin (PO)

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10
Q

Aminopenicillin spectrum

A

gram-pos

anaerobes

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11
Q

Penicillin + Beta-lactamase ibhibitor includes ?

A

amoxicillin + clavulanic acid (Augmentin) (PO)

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12
Q

Penicillin + beta lactamase inhibitor spectrum

A

gram-pos, enterococcus
gram-neg, pseudomonas earuginosa
anaerobes

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13
Q

Adverse effects of penicillins

A

allergic or hypersensitivity reaction - ocurrs in 3-10%

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14
Q

Adverse effects of cephalosporins

A

allergic or hypersensitivity reaction - ocurrs in 1-3%

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15
Q

1st generation cephalosporins include

A

Cephalexin (Keflex) (PO)

Cefazolin (Ancef) (IV)

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16
Q

Spectrum of 1st generation cephalosporins

A

gram-pos - including staph

limited gram-neg

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17
Q

2nd gen. cephalosporins include

A

cefaclor (Ceclor) (PO)

cefoxitin (Mefoxin) (IV)

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18
Q

Spectrum of 2nd generation cephalosporins

A

gram-pos - less staph coverage
increased gram-neg
anaerobes (Cefoxitin ONLY)

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19
Q

Which of the cephalosporins is the only one that’s spectrum covers anaerobes?

A

Cefoxitin aka Mefoxin (2nd gen.)

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20
Q

3rd gen. cephalosporins include

A

Cefriaxone (Rocephin) (IV, IM)

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21
Q

Spectrum of 3rd gen cephalosporins

A

limited gram-pos

superior gram-neg coverage

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22
Q

Spectrum for both Carbapenems and Monobactams

A

gram-pos, gram-neg, anaerobes and pseudomonas. Also organisms that produce ESBLs.

The one monobactam has coverage only against aerobic gram-neg organisms.

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23
Q

Carbapenems include

A

Impenem/Cilastatin (Primaxin) (IV)

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24
Q

Why is cilastatin added to the carbapenem impenem?

A

to reduce the incidence of nephrotoxicity

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25
Q

The monobactam is

A

Aztreonam (Azactam) (IV)

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26
Q

Adverse effects of carbapenems and monobactams

A

nausea/vomiting

seizures

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27
Q

What is the mechanism of action of fluoroquinolones?

A

They inhibit bacterial DNA synthesis by inhibiting DNA-gyrase (topoisomerases) so the result is DNA strands breaking (bactericidal)

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28
Q

Fluoroquinolones include

A

Ciprofloxacin (Cipro) (IV, PO)
Levofloxacin (Levaquin) (IV,PO)
“Respiratory fluoroquinolones”

29
Q

Spectrum of activity of the fluoroquinolones

A
  • limited gram-pos - staph and strep
  • exellent gram-neg - cipro and levofloxacin have activity against pseudomonas aeruginosa
  • anaerobic activity
  • atypical organisms: legionella, mycoplasma, chlamydophila
30
Q

What are the safety considerations with fluoroquinolones?

A

contraindicated in: pregnant women and children 18 yrs or younger b/c of risk of cartilage destruction
Caution in elderly - may cause diziness

31
Q

macrolides are commonly used for . . .

A

respiratory infections including rhinosinusitis, otitis media, bronchitis and community-acquired pneumonia

32
Q

Macrolides mechanism of action

A

Binds to 50s ribosomal subunit of bacteria to inhibit RNA-dependent protein synthesis

33
Q

Macrolides spectrum

A

gram-pos
limited gram-neg
limited anaerobe

34
Q

Macrolides include

A

Erythromycin (IV, PO)
Clarithromycin (Biaxin) (PO)
Azythromycin (Zithromax) (IV, PO)

35
Q

What are the most common adverse effects of macrolides?

A

GI symptoms

36
Q

What is the mechanism of action of tetracyclines?

A

inhibition of 30S subunit which inhibits protein synthesis, causes cell wall impairment and cell death

37
Q

tetracylclines spectrum of activity?

A

gram-pos: including community-aquired MRSA
gram-neg
anaerobes (limited)

38
Q

Tetracyclines include

A

Doxycycline (IV, PO)
Tetracycline (PO)
Minocycline (IV, PO)

39
Q

Adverse effects of tetracyclines

A

GI symptoms, phototoxicity, tooth discoloration. Contraindication in children under 8 and in pregancy .

40
Q

What are the significant drug interactions of tetracyclines?

A

impaired w/ cations and dairy products

41
Q

What is the spectrum of activity of sulfonamides?

A

gram-pos
gram-neg
protozoa
community-aquired MRSA

42
Q

What is the most common form of a sulfonamide?

A

sulfamethoxazole combined with trimethoprim. Trimethoprim + sulfamethoxazole (TMP/SMX) (Bactrim®) is frequently prescribed for the treatment of urinary tract and skin infections, including skin infections caused by community-acquired MRSA

43
Q

The sulfonamides include

A

Sulfamethoxazole

Trimethoprim

44
Q

Mechanisms of action of sulfonamides

A

sulfamethoxazole - competes w/ para-amino benzoic acid to inhibit bacterial synthesis of dihydrofolic acid
Trimethoprim - inhibits dihydrofolate reductase which inhibits prodcution of tetrahydrofolic acid
both of which lead to a bactericidal effect

45
Q

Adverse effects of sulfonamides

A

hypersensitivity or allergic reaction (3-5% have sulfa allergy)

46
Q

What are the safety considerations for sulfonamides?

A

caution in 1st trimester and avoid in 3rd. avoid in infants less than 2 mos and breast feeding mothers of children less than 2 mos. causes kernicterus

47
Q

Drug interactions of sulfonamides

A

Warfarin. Sulfamethoxazole increases anticoag effects increasing the risk for bleeding

48
Q

Clindamycin is commonly used for ?

A

skin infections, vaginal infections, oral infections, acne and anaerobic coverage (above the diaphragm).

49
Q

Spectrum of activity of clindamycin

A

gram-pos (including MRSA)

anaerobes

50
Q

mechanism of action of clindamycin

A

binds to 50S and inhibits RNA-dependent protein synthesis

51
Q

Adverse effects of clindamycin

A

Antibiotic-associated diarrhea may result from the overgrowth of Clostridium difficile; this infection in the GI tract may even lead to a severe colitis requiring colectomy in extreme cases

52
Q

Metronidazole is commonly used in ?

A

anaerobic (below diaphragm) and protozoal infections. It is often added to an antimicrobial regimen for additional anaerobic coverage (GI, GU).

53
Q

The name brand of metronidazole is ?

A

Flagyl (IV, PO, topical)

54
Q

spectrum of activity of metronidazole

A

anaerobes
protozoa
c-diff

55
Q

mechanism of action of metronidazole

A

inhibits nucleic acid synthesis resulting in cell death

56
Q

Adverse effects of metronidazole

A

GI symptoms

disulfram like reactions occur when combined w/ alcohol

57
Q

Vancomycin is commonly used when?

A

used in the hospital setting for empiric coverage for resistant Gram-positive organisms (e.g. MRSA). It should only be chosen for therapy when no other alternatives are available to reduce the incidence of resistance.

58
Q

What is the spectrum of activity of vancomycin?

A

gram-pos - especially strep, staph, and enterococci (except VRE)

59
Q

What is the mechanism of action of vancomycin?

A

inhibits bacterial cell wall synthesis (bactericidal) by inhibiting peptidoglycan polymerase

60
Q

Adverse effects of vancomycin

A

Red Man’s Syndrome

Nephrotoxicity - uncommon

61
Q

The aminoglycosides include

A

Gentamicin (IV)

Tobramycin (IV)

62
Q

mechanism of action of aminoglycosides

A

Binds to 30S and 50S to inhibit bacterial protein synthesis (bactericidal)

63
Q

Spectrum of activity of aminoglycosides

A

aerobic gram-negs: including pseudomonas aeruginosa and enterobacteriaceae
gram-pos (gentamicin only) but never alone, usually paired w/ beta-lactams

64
Q

adverse effects of aminoglycosides

A

nephrotoxicity - often reversible

ototoxicity - often irreversible

65
Q

What is a pathogen?

A

a microorganism capable of causing disease. not all bacterial are pathogens.

66
Q

commensal pathogens

A

commonly found as part of our normal flora, meaning they live in or on our body (the host) in a non-infectious way.
colonize all “external” parts of the body where external would refer to access to the outside world (e.g., the respiratory tract and the GI tract are included in this definition of “external”)
given proper conditions, have the potential to cause disease

67
Q

professional pathogens

A

a. are not a part of normal flora, but, when introduced to the body, can elude host defenses and cause infection fairly easily
b. only role in humans are as infectious agents
c. efficiently enter the body
d. are capable of multiplying rapidly

68
Q

opportunistic pathogens

A

a. Are bacteria that can cause infection but normally require some alteration of the immune system
b. may or may not be part of the normal flora

Pharmacology (9 decks)

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