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Erica Pharm 2 Exam > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

What are the 4 MOA’s of antibacterials?

A
  1. inhibitors of cell wall synthesis
  2. inhibitors of translation and transcription
  3. inhibition of DNA synthesis
  4. inhibitors of folate synthesis and function
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2
Q

What are some abx that act as inhibitors of cell wall synthesis?

A

Beta-lactams penicillins
Cephalosporins
glycopeptides: Vanco
TB meds

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3
Q

What are some abx that act as inhibitors of translation and transcription?

A 
Tetracyclines
Macrolides
Clindamycin
Oxazolidinones
Aminoglycosides
Spectinomycin
TB meds
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4
Q

What abx act as inhibitors of DNA syntheses/integrity as well as folate synthesis and function?

A

sulfonamides, Trimethoprim

Quinolones

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5
Q

MOA for bactericidal abx’s

A

generally inhibition of cell wall synthesis

  • time-dependent killing: serum level above MIC (i.e. beta-lactams and vanco)
  • concentration-dependent killing: higher drug concentration determines rate and extent of killing (aminoglycosides and quinolones)
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6
Q

MOA of bacteriostatic abx’s

A

generally inhibition of protein synthesis

- i.e. Tetracyclines, macrolides, sulfonamides

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7
Q

What is the post-antibiotic effect?

A

Persistent suppression of bacterial growth after limited exposure to an antimicrobial agent

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8
Q

Which drugs need a dosage adjustment for renal impairment?

A 
aminoglycosides
carbapenems
cephalosporins
penicillins
trimethoprim-sulfamethoxazole
vancomycin
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9
Q

What drugs are contraindicated in renal impairment?

A

Nitrofurantoin, sulfonamides (long-acting), tetracyclines

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10
Q

What drugs need a dosage adjustment in hepatic impairment?

A

Chloramphenicol, clindamycin, erythromycin (Z-pack), metronidazole

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11
Q

Which Penicillins are considered narrow spectrum?

A

Peniciilinase-susceptible –> Penicillin G and Penicillin VK

Penicillinase-resistant –> Nafcillin and Oxacillin

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12
Q

Which Penicillins are considered wider spectrum?

A 
\+/- penicillinase inhibitor:
Ampicillin
Amoxicillin
Piperacillin
Ticarcillin
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13
Q

What additional microorganisms are covered by amoxicillin but not by penicillin?

A

H. influenza

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14
Q

PK of Penicillin

A

rapid renal elimination

Biliary clearance - ampicillin, nafacillin

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15
Q

What are the ADE’s of Penicillin?

A

Hypersensitivity reactions (~5-6% incidence)

Maculopapular rash - ampicillin

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16
Q

What are the clinical uses for narrow and wider spectrum penicillins?

A

Narrow: strept, staph, meningococcal, syphilis

Wider: greater activity vs. gram-neg bacteria

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17
Q

List examples of medications in the 5 generations of Cephalosporins.

A 
1st -- Cephalexin
2nd -- Cefuroxime
3rd -- Ceftriaxone and Cefixime
4th -- Cefipime
5th -- Ceftaroline

[1st narrow —-> 5th broader]

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18
Q

PK of Cephalosporins

A

3rd generation drugs enter the CNS

renal elimination (aka dosage adjustment)

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19
Q

What are the ADE’s of Cephalosporins?

A
  • assume complete cross-reactivity b/t cephalosporins
  • 1st generation partial cross-reactivity w/penicillins
  • Hypersensitivity rxn’s
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20
Q

What cephalosporin is NOT given to newborns and why?

A

Ceftriaxone (Rocephin) bc it is cleared by the biliary tract –> elevated bilirubin

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21
Q

What are the clinical applications for each generation of Cephalosporins?

A

1st – skin, soft tissue, UTI
2nd – S. pneumo, H. influenza, B. fragilis (cefotetan)
3rd – pneumonia, meningitis, gonorrhea, broad activity, beta-lactamase stable
4th – psuedomonas coverage
5th – skin, soft tissue, CAP

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22
Q

Which generation of cephalosporins cross react w/ Penicillins?

A

1st generation

- may be linked to side chain in common

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23
Q

Which generations of cephalosporins can usu. be given safely to Penicillin allergic patients?

A

2nd, 3rd, 4th, maybe 5th

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24
Q

What are examples and ADE’s of Carbapenems?

A

Imipenem-cilastatin (Primaxin)
- also Doripenem, Meropenem, Ertapenem
ADE’s: CNS effects include confusion and seizures

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25
Q

Clinical application of Carbapenems?

A

Broad spectrum activity: Penicillin-resistant Strep pneumo, gram-neg rods, pseudomonas

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26
Q

Which beta-Lactam does not have a cross allergenicity w/other beta-lactams, and is only active against 3 gram negative bacteria? Name these bacteria.

A

Monobactams - active against Klebsiella, Pseudomonas, serratia

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27
Q

ADE’s for Monobactams

A

CNS - headache and vertigo

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28
Q

Glycoproteins include which drugs?

A

Vancomycin
Dalbavancin
Oritavancin
Telavancin (HA- bacterial pneumo)

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29
Q

What are the clinical applications for Vancomycin?

A

Gram-positive activity covers MRSA and PRSP (penicillin-resist strep pneumo) strains

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30
Q

PK for glycopeptides (Vanco)?

A
  • parental for systemic infections
  • Oral vancomycin for C. diff colitis (an IV dose will NOT work!)
  • renal elimination
31
Q

What are toxicities of glycopeptides?

A
  • Red-neck or red man syndrome –> erythematous rash on face and upper body
  • infusion rate related
  • rare nephrotoxicity
32
Q

____ is a Lipopeptide w/activity against MSSA & MRSA w/ ____ as a unique toxicity.

A

Daptomycin

Myopathy - monitor CPK weekly

33
Q

Clinical applications of Lipopeptides

A

Gram positive activity

  • Endocarditis and sepsis
  • Off-labeled uses: Osteomyelitis, prosthetic joint infections
  • MSSA and MRSA coverage
34
Q

What are Tetracyclines agents and what’s included on its activity spectrum?

A

DOXYCYCLINE, tetracycline, minocycline, tigecycline

anthrax, chlamydial, mycoplasma, rickettsiae
spirochetes, H. pylori

35
Q

ADE’s for Tetracycline

A

GI upset, deposition in developing bones and teeth, photosensitivity

36
Q

What can you treat w/ Tetracycline?

A

acne, CAP, bronchitis, cellulitis, lyme disease, periodontitis

37
Q

What are Macrolide agents and ADE’s?

A

AZITHROMYCIN, erythromycin, clarithromycin

ADE’s: GI upset, hepatic dysfunction, QT elongation, CYP450 inhibition (NOT azithro)

38
Q

Activity spectrum for Macrolides?

A

CAP, Pertussis, Corynebacteria (Diphtheria), Chlamydial

39
Q

Lincosamides: agent, activity spectrum, and ADE’s?

A

agent: Clindamycin
spectrum: skin, soft tissue infections, anaerobic infections

ADE’s: can cause C. difficile colitis

40
Q

Chloramphenicol activity spectrum

A
  • treatment of serious infection d/t organisms resistant to less toxic abx
  • bacteroides, H. influenza, salmonella, meningitides, rickettsia
  • active against many vancomycin-resistant enterococci
41
Q

ADE’s of Chloramphenicol

A

dose-related anemia (monitor CBC), gray baby syndrome

risk: serum levels >50mcg, patients w/impaired hepatic or renal function

42
Q

Oxazolidinone: agent, activity spectrum, and ADE’s?

A

Linezolid

activity: MRSA, PRSP, VRE strains

ADE’s: dose related anemia, neuropathy, optic neuritis, SSRI’s

43
Q

Aminoglycoside agents

A 
GENTAMICIN
Tobramycin
Amikacin
Streptomycin
Neomycin
44
Q

Aminoglycoside ADE’s

A

Nephrotoxicity (reversible)
Ototoxicity (irreversible)
Neuromuscular blockade

45
Q

Aminoglycoside activity spectrum

A

aerobic gram negatives, H. influenza, M. catarrhalis, Shigella species

Often used in combo w/ beta-lactams

46
Q

Anti-folate abx: MOA for sulfonamide and trimethoprim

A

Blockade of folic acid synthesis

47
Q

Trimethoprim-sulfamethoxazole (TMP-SMZ) activity spectrum

A

UTI, resp. infections (bronchitis), ear infections, MSSA or MRSA-skin/soft tissue infections, traveler’s diarrhea, toxiplasmosis,

48
Q

Combination of Trimethoprim-sulfamethoxazole (TMP-SMZ) is or bacteriostatic or bactericidal? Dosing is based on which component?

A

bactericidal

Trimethoprim component

49
Q

ADE’s of TMP-SMZ

A

rash, bone marrow suppression, hyperkalemia, fever

ADE’s esp. in AIDs pt’s

50
Q

What stage of pregnancy should TMP-SMZ be avoided?

A

1st trimester

51
Q

What is the activity spectrum for Quinolones?

A

urogenital infections, GI tract infections, bacterial conjunctivitis, activity vs. gonococci rapidly declining

52
Q

Which 2 quinolones are mainly used for UTI’s?

A

Ciprofloxacin

ofloxacin

53
Q

ADE’s of Quinolones

A 
CNS effects (dizzy, HA)
tendinitis (Achilles affected most)
Peripheral neuropathy
Neuromuscular-blocking activity
QTc prolongation

Avoid in young children & pregnancy

54
Q

Quinolones drug interactions

A

oral absorption impaired by cations - Ca, Mg, Al

caution w/use of class IA and III antiarrhythmic

55
Q

In what neuromuscular disease should quinolones be avoided?

A

Mesthenia Gravis

56
Q

What is synergism?

A

killing effects or 2 or more antimicrobials used together are significantly greater than expected from their effects when used individually (4X or greater)

57
Q

What is guided treatment?

A

effective antimicrobial agent identified by susceptibility testing of infecting microorganism

58
Q

What factors should be considered before empiric therapy is initiated?

A
  • Age, pregnancy, allergies
  • metabolic or genetic variation
  • renal and hepatic function
  • concomitant drug therapy and disease states
59
Q

What is an antibiogram?

A
  • report of susceptibility/resistance of pathogens to abx’s
  • can be used to determine empiric tx options
  • information about local resistance patterns
60
Q

MOA of Penicillins

A

inhibit bacterial cell wall synthesis

61
Q

MOA of Cephalosporins

A

inhibit cell wall synthesis

62
Q

MOA of Carbapenems

A

inhibit cell wall synthesis

63
Q

MOA of Monobactams

A

inhibits GRAM NEG bacterial cell wall synthesis

64
Q

MOA of glycoproteins

A

inhibit cell wall synthesis

65
Q

MOA of Lipopeptides

A

inhibit cell wall synthesis

66
Q

MOA of Tetracyclines

A

inhibit bacterial protein syntesis via binding to 30S ribosomal unit

67
Q

MOA of Macrolides

A

inhibit bacterial protein synthesis via binding to 50S ribosomal subunit

68
Q

MOA of Lincosamides

A

inhibit bacterial protein synthesis via binding to 50S ribosomal subunit

69
Q

MOA of Chloramphenicol

A

inhibit bacterial protein synthesis via binding to 50S ribosomal subunit

70
Q

MOA of Oxazolidinone

A

inhibit bacterial protein synthesis via binding to 23S RNA of 50S ribosomal subunit

71
Q

MOA of Aminoglycosides

A

inhibit bacterial protein synthesis via binding to 30S ribosomal subunit

72
Q

MOA of anti-folates

A

blockade of folic acid synthesis

73
Q

MOA of Quinolones

A

inhibit DNA replication via binding to DNA gyrase and topoisomerase IV

Erica Pharm 2 Exam (3 decks)

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