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Pharmacology > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Cephalosporin

A

Beta Lactation antibiotics that are derived from acrimonious fungus

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2
Q

MOA cephalosporins

A

Inhibit bacteria wall synthesis

Bactericidal

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3
Q

Are cephalosporin penicillinase resistant

A

Yup

Not susceptible to penicillinases

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4
Q

Each new generation of cephalosporin has greater gram _ properties

A

Negative

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5
Q

Side effects cephalosporin

A

Hypersensitivity reactions vitamin k defiency
Disulfiram like reaction with alcohol
Increased nephrotoxicity of aminoglycosides

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6
Q

Hypersensitivity cephalosporin

A

Same with penicillin
Careful giving to people with penicillin allergies

Rashes, hives, itchy eyes, swollen tongue

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7
Q

Cephalosporin vitamin k

A

Cephalosporin activates vitamin k, causing defiency

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8
Q

Alcohol and cephalosporin

A

Disulfiram like reaction-flushing, fast heartbeat, nausea, thirst, chest pain, vertigo, low bp

Occurs as a result of accumulation of acetaldehyde due to inhibition of acetaldehyde dehydrogenase

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9
Q

Increased nephrotoxicity of aminoglycosides with cephalosporin

A

Demonstrate synergistic nephrotoxicity interaction when used in combination

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10
Q

1st generation cephalosporin

A

Beta Lactation antibiotics that are derived from acrimonious fungus. Inhibit bacterial cell walls ynthesis. Not susceptible to peniciliinases.

Not strong gram -

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11
Q

Examples of first generation cephalosporin

A

Cefazolin and cephalexin

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12
Q

What are 1st gen cephalosporin effective against

A

Proteus mirabilis, E. coli, klebsiella pneumonia and gram positive cocci

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13
Q

Cefazolin

A

Intramuscular
Gram + bacterial infections of the skin but more severe infections involving bon,e lungs, GI and urinary tract. Also pre operative prophylaxis

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14
Q

Cephalexin

A

Orally

Gram positive infections int he middle ear, bone, lungs, and skin. Also endocarditis prophylaxis

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15
Q

Indications for 1st gen cephalosporin

A

Proteus mirabilis
E. coli
Klebsiella
Gram positive cocci

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16
Q

2nd gen cephalosporin

A

Cefoxitin, cofactors and cefuroxime

For proteus mirabilis, E. coli, klebsiella, haemophilus influenza, enterobacter, neisseria, serratia marcescens and gram positive cocci

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17
Q

Cefoxitin

A

Gram negatives, gram positive and even anaerobes.

NOT for active against pseudomonas and enterococci

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18
Q

Cefaclor

A

For septicemia, pneumonia peritonitis, UTI and biliary tract infections. It is active against both gram positive and gram negative bacteria

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19
Q

Cefuroxime

A

Unlike other second generations can cross the BBB and is active against haemophilus influenza, neisseria gonorrhea and Lyme disease

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20
Q

Indications for 2nd generation

A 
Proteus mirabilis
E. coli
Klebsiella
Gram positive cocci
Haemophilus influenza
Enterobacter
Neisseria
Serratia marcescens
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21
Q

3rd generation cephalosporin

A

Ceftriaxone, cefotaxime, and ceftazidime

Broad spectrum
Good against gram negative organisms resistant to other beta lactate

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22
Q

Cefotaxime

A

Respiratory infections, CT, urinary tract, genita tract, meninges, and blood. Can cross the BBB

Most gram negative bacteria (espicially pseudomonas) also gram positive cocci, except enterococcus

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23
Q

Ceftriaxone

A

Community acquired pneumonia, haemophilus influenza infection, and can be used for bacterial meningitis.
GONORRHEA from dingle muscular injection
Can cross the BBB

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24
Q

Cefdinir

A

Pneumonia, bronchitis, ear infections, sinusitis, pharyngitis, tonsillitis, skin infections.

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25
Q

Side effects cefdinir

A

Can bind iron in GI and cause red stool

Diarrhea, vaginal infections, nausea, head ache, abdominal pain

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26
Q

Ceftazimidime

A

Gram positive and gram negative bacteria. ACTIVE AGAINST PSEUDOMONAS

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27
Q

Whic third generation cephalosporin should i use for pseudomonas

A

Ceftazidime

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28
Q

Indications for 3rd gen cephalosporin

A

Serious gram negative infections, which are typically resistant to other beta Lactation antibiotics

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29
Q

4th gen cephalosporins

A

Cefepime
Broad spectrum of activity and further increased activity against gram negative organisms resistant to other beta lactams

Used for pseudomas a

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30
Q

Cefepime

A

For moderate-severe hospital acquired infections by multi resistant bacteria such as pseudomonas and can cover resistant strep p as well as enterobacteriaceae

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31
Q

Indications 4th gen cephalosporin

A

Increased activity against gram positive infections and pseudomas and gram positive infections like staph a…also gram -

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32
Q

5th generation cephalosporin

A

Broad spectrum

Specifically created for resistant organisms such as MRSA

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33
Q

Indications 5th generation cephalosporin

A

Resistant bacteria like MRSA

Broad spectrum against gram positive and gram negative

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34
Q

Examples of 5th generation cephalosporin

A

Ceftobiprole

Ceftaroline

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35
Q

Ceftobiprole

A

Antipseudomonal (binds strongly to penicillin binding protein 2a)
MRSA, strep p, enterococci, health care associated pneumonia (powerful antipseudomnonal)
MRSA which are less susceptible to daptomycin , vancomycin or linezolid

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36
Q

Ceftaroline

A

Broad spectrum activity against many gram positive organisms, such as MRSA, MRSE, and VRE.
Not great for gram - bacteria like bacteroides
NO PSEUDOMONAS COVERAGE

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37
Q

Protein synthesis inhibitors

A

Slows or stops the growth or proliferation of cells by disrupting the generation of new proteins, usually the ribosome level

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38
Q

Protein synthesis inhibitors prok vs euk

A

Effect only prokaryote 30 50s =70s

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39
Q

Protein synthesis inhibitors of 30s ribosome

A

Aminoglycosides

Tetracyclines

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40
Q

Protein synthesis inhibitors 50s

A 
Chloramphenicol
Clindamycin
Erythromycin
Linomycin
Linezolie
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41
Q

Aminoglycosides

A

Bactericidal

Inhibit formation of the initiation complex and cause misreading of. MRNA. They require oxygen for uptake and are ineffective against anaerobes and are typically used for severe gram - rod infections

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42
Q

Tetracyclines

A

Bacteriostatic

Prevent attachment of 30s to aminoacyl-trna

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43
Q

Examples of tetracyclines

A

Doxyclycline
Demeclocycline
Minocycline

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44
Q

What are tetracyclines used for

A

Lyme
H pylori
M pneumoniae
Rickettsia and chlamydia

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45
Q

Chloramphenicol

A

Bacteriostatic inhibits 50s peptidyltransfersase

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46
Q

Why is chloramphenicol rarely used in the US and more in developing countries

A

Severe toxicities-anemia, plastic anemia and gray baby syndrome
But its cheap

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47
Q

Clindamycin

A

Bacteriostatic

Blocks peptide bond formation at 50s

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48
Q

What in clindamycin used for

A

Bacteroides fragility and clostridium perfringens above the diaphragm

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49
Q

Erythromycin

A

Inhibits protein synthesis by binding to the 23 rRNA and 50s subunit and blocking translocation

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50
Q

What in erythromycin used for

A

Atypical pneumonia caused by mycoplasma, chlamydia and legionella as well as URI and TDS

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51
Q

Lincomycin

A

Binds 50s similar structure to macrolides

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52
Q

Why in lincomycin rarely used

A

Adverse effects and toxicity

Reserved for patients with penicillin allergies and high resistant bacteria

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53
Q

Linezolid

A

Binds 50s for gram positive infections that are resistant to other antibiotics like strep, vancomycin resistant enterococci, mrsa

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54
Q

Indication for linezolid

A

Infections of skin, soft tissue and hospital acquired pneumonia

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55
Q

Linezolid (zygote)

A

Bacteriostatic part of oxazolidinone class inhibit 50s

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56
Q

What is linezolid used for

A

Gram positive causes of pneumonia and skin infections as well as MRSA and WRE

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57
Q

Why linezolid not commonly used

A

Expensive, severe adverse effects, hard to obtain

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58
Q

Side effects linezolid

A

Bone marrow suppression, serotonin syndrome

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59
Q

What is linezolid used for

A

Drug resistant organisms!

60
Q

What is the oxaxolidinone family

A

Heterocyclic, nitrogen containing, organic 5 members ring compound. Approved by FDA in 2008

61
Q

MOA linezolid

A

Binds 23 rRNA of 50s to prevent formation of functional 70s

Inhibits protein synthesis
Bacteriostatic

62
Q

Indication linezolid

A

Gram positive organisms
(Staph and strep)
MRSA
VRE

63
Q

Side effects linzidolin

A

Bone marrow suppression (decreased palatable count)
Peripheral neuropathy
Lactic acidosis
Serotonin syndrome

64
Q

When on linezolid taken with tyramine containing for

A

BAD get tyramine excess causing dangerous bp changes and the associated symptoms of chest pain, tachycardia, confusion, headaches, nausea, and vomiting, vision changes epistaxis and anxiety

65
Q

Aminoglycosides

A

Irreversibly bind 30S interfere proofreading and can inhibit translocation of peptidyl tRNA and can disrupt bacterial cell membrane

66
Q

Indication for aminoglycosides

A

Gram negative aerobes (pseudomonas, enterobacter, mycobacteria)
Serious septicemia, GI infections, UTI and hospital acquired pneumonia

67
Q

Why do aminoglycosides not work well with anaerobic bacterial infections

A

Require oxygen uptake by bacteria

68
Q

Side effects aminoglycosides

A

Nephrotoxicity and ototoxicity

69
Q

Why aminoglycosides cause nephrotoxicity

A

Inhibits protein synthesis in renal cells and can lead to acute tubular necrosis and renal failure…common when given with cephalosporins

70
Q

Ototoxicity is common when aminoglycosides are given with ___

A

Loop diuretics

71
Q

Pregnancy and aminoglycosides

A

No teratogen

72
Q

Resistance to eminoglycosides

A

Yea due to certain transferase enzymes that inactivate the drug. They alter the structure of aminoglycosides through various chemical reactions such as acetylation, adenylation or phosphorylation

73
Q

Example of aminoglycosides

A 
Gentamicin
Neomycin
Amikacin
Tobramycin
Streptomycin
74
Q

Gentamicin

A

For gram negative infections such as pseudomonas and proteus, but is not for neisseria of legionella.

75
Q

Gentamicin side effects

A

Ototoxicity and nephrotoxicity

76
Q

Administration gentamicin

A

Not orally due to lack of SI absorption

77
Q

Why is gentamicin often used to coat surgical implants and told

A

Heat stable

78
Q

Neomycin

A

For bowel surgery prep
Highly ototoxicity and nephrotoxicity
Not absorbed in intestine

Treats hepatic encephalopathy by eliminating ammonia producing bacteria inthe intestine or to reduce the risk of infection during intestinal surgery by eliminating intestinal bacteria

79
Q

Amikacin

A

Pseudomonas, enterobacter, serratia infections,
Nephrotoxicity
Ototoxicity.
Can’t be given orally and dosing should be carefully monitors with renal failure

80
Q

Tobramycin

A

Gram negative infections , better than gentamicin with pseudomonas lung infections

Can’t be given orally
In ophthalmic solution (tobrex) for bacterial conjunctivitis.
Ototoxicity and nephrotoxicity

81
Q

Streptomycin

A

Mycobacterium tb
Endocarditis, yersinia pestis infestation and tb

Ototoxicity and nephrotoxicity

82
Q

MOA aminoglycosides

A

Bactericidalbind 30s and inhibit formation of the initiation complex required to translate abcteria mRNA cause misreading of RNAand premature termination or protein synthesis
-interferes with proofreading

RequiresO2 uptake
Only aerobes

83
Q

Resistance to amionglycosidases

A

Transferase enzymes in plastics and transposons

Acetyltransferases, phosphotransferases and adenyltransferases

84
Q

Indications for aminoglycosides

A

Gram negative rod infections
Synergistic with b lactma antibiotics-can add espicially for endocarditis
(Ampicillin and gentamicin)

85
Q

Side effects eminoglycosides

A

Nephrotoxicity espicially when used with cephalosporin

Ototoxicity with look diuretics (furosemide)
Teratogen-category D

86
Q

Macrolides

A

Macrolides lactone ring
Bind 23s rRNA of 50s to block translocation
Bacteriostatic

87
Q

Examples of macrolides

A

Erythromycin, azithromycin and clarithromycin

88
Q

Indication for macrolides

A

Gram positive cocci, atypical pneumonia’s, chlamydia

89
Q

Resistance to macrolides

A

Alteration of 23S RRNA binding side, usually by post transcriptional methylation

90
Q

Macrolides are potent inhibitors of __, espicially ___

A

Cytochrome p450

CYP3A4…can elevate other drugs

91
Q

What combination should be voided with macrolides

A

Statins—-MTOPATHY

92
Q

Side effects macrolides (erythromycin and clarithromycin)

A

QT prolongation ,which can lead to torsades de pointes

93
Q

Macrolides exhibit enterohepatic recycling. What’s that

A

Absorbed int he gut and sent to the liver where it is excreted back into the duodenum in bile…can lead to buildup and cause nausea and GI distress (diarrhea)

94
Q

Macrolides and liver

A

Hepatotoxicity-direct and immunoallergic effect..

Is immunoallergic will get rash and peripheral eosinophils

95
Q

MOA macrolides

A

Bacteriostatic

96
Q

Erythromycin

A

GI disturbances be is a motility agonist. Can treat gastroparesis

Prolonged QT

97
Q

Azithromycin (Zithromax or Zmax)

A

Derived from erythromycin

Prevents bacterial infections, espicially middle ear infections, strep throat , pneumonia, and sinusitis. Also effective against STD (chlamydia)

Cardiovascular effects-qT prolongation

98
Q

Clarithromycin

A

Treat pharyngitis, tonsillitis, maxillary sinusitis, pneumonia and acut bacterial exacerbation of chronic bronchitis.

99
Q

Why can clarithromycin be taken orally

A

Acid stable and best bioavailability

100
Q

Indication for macrolides

A

Gram positive cocci
Atypical pneumonia
Chlamydia

101
Q

Resistance to macrolide

A

Alterations of the 23s rRNA binding site usually by post transcriptional methylation

102
Q

Macrolides side effects

A 
Diarrhea
Prolonged qt interval
P450 inhibitors
Cholestatic hepatitis
Skin rash 
Eosinophilia
103
Q

Neomycin sulfate

A

Aminoglycoside that targets aerobic gram negative bacilli

Not absorbed in GI tract and do not enter CSF

104
Q

Indication for neomycin sulfate

A

Topical infection

Prophylaxis for patients scheduled for intestinal surgery

105
Q

Side effects neomycin sulfate

A

Ototoxicity, nephrotoxicity, rash, blood dyscrasias

Monitor patients for GI superinfection

106
Q

MOA neomycin sulfate

A

Aminoglycoside disrupts protein synthesis and causes rapid bacterial death. Bactericidal

107
Q

Side effects neomycin sulfate

A

Ototoxicity, nephrotoxicity, rash, blood dyscrasias

GI superinfection -minotor

108
Q

Penicillin

A

From penicillium fungi
Penicillin G, V, benzathine

All are beta lactate antibiotics

Widely used for gram positive organisms and spirochetes

109
Q

MOA penicillin

A

Binds to penicillin binding protein which is also known as the enzyme transpeptidase, a critical enzyme involved int he peptidoglycan cross linking in the bacterial cell wall…death from osmotic pressure induced cytoplysis

Small size allows it to penetrate deeply into the cell wall
Also activates autolytic enzymes inth e bacteria to cause cell death

110
Q

Penicillin bacteriostatic or bactericidal

A

Bactericidal

Causes cell death

111
Q

Side effects penicillin

A

Hypersensitivity

Immune mediated hemolysis due to a haten mechanism, which is when the antibodies target the combination of penicillin in Association with the rbc and activate complements to induce hemolysis and removal of rbc

112
Q

Indications for penicillin

A 
Gram positive (bc inhibit formation of peptidoglycan cross linking in the bacterial cell wall)
Spirochetes-syphilis
113
Q

MOA penicillin

A

Binds PBP(component of bacterial cell wall and involved in cell wall synthesis)

Blocks transpeptidase cross linking of the cell wall

Activates autolytic enzymes

Bactericidal

114
Q

Side effect penicillin

A 
Hypersensitivity
Hemolytic anemia(immune mediated hemolysis of rbc via hapten mechanism in which antibodies are targeted against the combination of penicillin attached to rbc-> complement activation and removal of rbc by spleen)

Beta lactamse sensitive

115
Q

Beta lactamase

A

Enzymes produced by some bacteria to cleave beta lactate antibiotics

116
Q

Beta lactamase sensitive bacteria

A

Susceptible to cleavage by beta lactamase and are likely to be ineffective against beta lactamase producing bacteria

117
Q

Aminopenicillin mechanisms

A

Beta lactam
Inhibit PBP
Bactericidal

Broader spectrum of activity than penicillin and are not degraded by acid hydrolysis and can be given orally

118
Q

Are aminopenicillin beta lactamase sensitive

A

Yup

119
Q

What are aminopenicillin given with to prevent beta lactamase isssues

A

Clavulanic acid-beta lactamase inhibitor

120
Q

Indication for aminopenicillin

A

Most gram positive infections and some gram negative(e coli and H influenza)

121
Q

Common aminopenicillin

A

Ampicillin and amoxicillin

122
Q

Adverse reactions to aminopenicillin

A 
Hypersensitivity
Ampicillin rash (when given for mono)
Pseudomembranous colitis
123
Q

Indications for aminopenicillin

A

Some gram _(e coli and H influenza

Gram +

124
Q

Ampicillin

A

Gram + and limited gram negative

Rash with mononucleosis

125
Q

Amoxicillin

A

For otitis media, skin infections, and strep throat

Susceptible to beta lactamse producing bacteria so is combined with clavulanic acid

126
Q

MOAaminopenicillin

A

Beta lactamase sensitive

Given with beta lactamase inhibits like clavulanic acid

127
Q

Clavulanic acid

A

Beta lactamase inhibitor tha tis commonly combined with penicillin to overcome resistance

Suicide inhibitor-covalently binds to the active site of beta lactamase, thus inactivating it.

Commonly combined with amoxicillin and is called augmentin

128
Q

Side effects aminopenicillin

A

Hypersensitivity
Ampicillin rash
Psudomembranous (with mono/EBV and ampicillin)

colitis(colon infection with foul smelling diarrhea, fever, and abdominal paid cause by c diff)

129
Q

Ampicillin and amoxicillin

A

Broad spectrum penicillin antibiotics that work by inhibiting enzymes that are key in bacterial cell wall synthesis, eventually leading to cell lysis or rupture

130
Q

What are ampicillin and amoxicillin effective against

A

Gram + and some gram -

NOT staph a, unless given with beta lactamase inhibitor

131
Q

Indications for amoxicillin and ampicillin

A

Gram + (strep p, clostridium tetani) and some gram - (haemophilus influenza, E. coli, salmonella, and shigella)

132
Q

Side effects ampicillin amoxicillin

A

Rash diarrhea (more in ampicillin than amoxicillin)

Take probiotics

133
Q

Are amoxicillin and ampicillin good for staph a

A

No bc it has a beta lactamase

134
Q

What are clavulanic acid and amoxicillin called together

A

Augmentin

135
Q

What are ampicillin and sulbactam called together

A

Unasyn

136
Q

Allergic reaction to ampicillin and amoxicillin

A

Rash to anaphylaxis(immediate or 30 min)

If have allergy history don’t give

137
Q

When get ampicillin rash

A

If accidentally soused for patients with MONO

138
Q

Amoxilccin indication

A

Otitis media, skin infections, strep throat.

139
Q

Indications for aminopenicillin

A 
Shigella
Haemophilus influenza
Salmonella
Listeria
Enterococci
Proteus mirabilis
E. coli
140
Q

Antipseudomonal penicillins/carboxypenicillins

A

Have extra carboxylic acid group
Beta lactam
Bind PBP
Bactericidal

141
Q

What do antipseudomonal penicillins work against

A

Gram negative organisms like pseudomonas a and proteus mirabalis

142
Q

Antipseudomonal penicillins sensitive to beta lacatamase

A

Yup give with clavulanic acid

143
Q

Common antipseudomonal penicillin

A

Ticarcillin
Carbenicillin
Piperacillin

144
Q

Ticarcillin

A

Injectable used for pseudomonas infections

145
Q

Carbenicillin

A

Limited coverage against gram +

146
Q

Piperacilin

A

For pseudomonal infections
Given with tazobactam

IV or IM NOT ORAL

147
Q

Side effects antipseudomonal penicillin

A

Hypersensitivity

Pharmacology (52 decks)

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