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Pharm > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

What are the 3 General Mechanisms of Bacterial Destruction?

A

Cell Wall Disruption
Enzymatic Inhibition
Protein Synthesis Disruption

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2
Q

Name the general Beta Lactam Antibiotics (PCCM) and the mechanism of action

A 
Penicillin
Cephalosporin
Carbapenems
Monobactams
MOA: Bactericidal effects by interfering with ability to form the cell wall; cell swell and burst
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3
Q

What is Beta Lactamase and name the three Beta Lactamase Inhibitors (-bactam +CA)

A

Beta Lactamase is produced by bacteria to inactivate antibiotics
Sulbactam
Clavulanate (Clavonic Acid)
Tazobactam

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4
Q

What is penicillinase and name the 4 Penicillinase Resistant Penicillins (think oxa +Naf)

A 
Some bacteria produce penicillinase that destroys beta lactam ring - making penicillin ineffective
Dicloxacillin
Cloxacillin
Oxacillin
Naficillin
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5
Q

Do not mix penicillin with ____ in same IV solution

b/c it inactivates _____.

A

Aminoglycosides for both answers (usually added to regime to increase killing of pseuonomas)

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6
Q

What are the penicillin A/E

A

GI: N/V & Diarrhea & Abd Cramp
Glossitis -inflammed tongue, Somatitis - swelling/sores in mouth, Furry Tongue
Hypersensitivity Rxn: Rash
Pruritus (itching)
Fever
Anaphylaxis (5-10% of ppl- within 2-30min ):
Laryngeal Edema
Bronchoconstriction
Hypotension
Pain/Itching @ injection site

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7
Q

Name the three alternatives to use and the two not to use if penicillin anaphylactic reaction is intact?
Which one can be used if there is simply a mild allergy to PCN?

A

Use: Vancomycin, Clindamycin, Macrolides
Avoid: Cephalosporin or Carbapenems (cephalosporin can be used as alternative if mild allergy to PCN)

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8
Q

What is the name of the broad spectrum Penicillin that can cross BBB?

A

Ampicillin

Amoxicillin is the only other broad spectrum in class - both inactivated by beta lactamase

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9
Q

What are the beverages to avoid when taking penicillin - can decrease effectiveness

A

Caffine-containing beverages
Fruit Juices
Tomato Juice
(and citrus fruits)

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10
Q

How many generations of cephalosporins are there?

A

5 (all cephalosporins commonly start with cef or cep)

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11
Q

1st and 2nd generation cephalosporin commonly used against ______ and limited against ____.

A

Used: Gram Positive
Limited: Gram Negative

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12
Q

Name the two common 1st Generation Cephalosporin Drugs (think ceph)

A

Cephalexin & Cephazolin

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13
Q

Name the two common 2nd Generation Cephalosporin Drugs (think cef)

A

Cefoxitin

Cefuroxime

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14
Q

Name the two common third generation cephalosporin drugs (think ceft)

A

Ceftazidime

Ceftriaxone

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15
Q

Which generation is the only cephalosporin approved to treat MRSA - Name the drug

A

5th Generation (Ceftaroline)

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16
Q

Which generation of cephalosporin is used against gram negative microbes?

A

Third Generation

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17
Q

Ceftazidime is active against pseudomonas. What drug class is often given to enhance it’s killing effects?

A

Aminoglycosides

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18
Q

Which generation of cephalosporin is most effective against meningitis?

A

Third Generation

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19
Q

Which two cephalosporin generations are possibly responsible for C.Diff spread?

A

Third and Fourth

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20
Q

What are the cephalosporin A/E

A

(Common to penecillin)

Diarrhea, Abd cramps, Rash, pruritis, redness, edema

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21
Q

What happens when cephalosporin interacts with antacid, iron, probenecid, or oral contraceptives?

A

Antacids & Iron - Dec. effectiveness of drug
Probenecid - Dec. renal excretion
Oral Cont. - Enhances OCP metabolism; inc. risk of pregnancy

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22
Q

When given ceftriaxone and calcium together, what happens? (in neonates)
Necessary precautions to take?

A

Form fatal precipitates (solids that fall out into sol’n) in lungs and kidney
Dont give through same line OR differeent lines unles 48 hours in between them - In all other patients, may be given sequentially through same line (must flush between solutions)

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23
Q

What is the cephalosporin drug that can not be given with calcium?

A

Ceftriaxone

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24
Q

Which antimicrobial drug class has the broadest action of all antibiotics up to date?

A

Carbapenems

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25
Q

What are the drugs in carbapenem class?(give suffix)

A

-penem

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26
Q

Carbapenems must be infused for how long?

A

over 60 minutes

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27
Q

All carbapenems interacts with ____ to reduce blood levels of that drug. (what is drug used for)
What is the effect?

A

Valproate - used to control seizures

May cause seizures (also lowers seizure threshold)

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28
Q

What are the carbapenems A/E?

A

Similiar to penicillin

- mild diarrhea, abd cramps, rash, pruritis, redness, edema

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29
Q

Imipenem is rapidly inactivated by _______ (enzyme in kidney)
Which drug is combined to inhibit that enzyme?

A

Dipeptidase; 70% of imipenem is excreted unchanged in urine - 1/2 life of about 1 hour because of this enzyme

Cilastatin inc. half life and tissue penetration

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30
Q

Only monobactam drug in class?

A

Azactam

31
Q

All A/E and MOA in these classes of antibiotics are very similar, almost identical - Name them

A

Penicillin
Carbapenems
Cephalosporins
Monobactam

32
Q

What is the name of aminoglycosides? (suffix)
What is their MOA?
Concentration or time dependent?

A

-mycin

rapid bactericidal action through disruption of protein synthesis (30S Ribosome) - Concentration dependent

33
Q

Aminoglycosides are used to treat aerobic or anaerobic bacteria / gram negative or gram positive? bacteria?

A

Aerobic gram negative bacteria
(“glycosides” require O2 for transport across bacteria cell membrane- anaerobic environment doesn’t allow transport)
Inactive against most gram positive bacteria

34
Q

Which aminoglycoside is least susceptible to inactivation by bacterial enzymes?

A

Amikacin

35
Q

Two major adverse effects of aminoglycosides (NO!)

A

Ototoxicity - impairment of hearing and balance; can be irreversible; R/T excessive trough levels (NOT Peak)
Nephrotoxicity - generally reversible; binds tightly to renal tissue achieving 50x dose of that in serum levels -> Acute Tubular Necrosis

36
Q

Other A/E of aminglycosides?

A

Hypersensitivity rxn: rash, pruritis (itching), urticaria (hives)
Blood Dyscrasias
Neuromuscular blockade –> causes paralysis of affected skeletal muscle

37
Q

What is the name of macrolides? (suffix)

What is their MOA?

A

-thromycin

inhibition of protein synthesis (50s ribosome)

38
Q

Do not administer metal ions 2 hours before or after taking this drug in macrolide class?

A

Azithromycin (Some antacids contain metal ions)

39
Q 
What is function of cytochrome p450?
Which drug in macrolide class is the only one that does not affect this enzyme? 
All others do what to it?
A

Metabolize toxic compounds (drugs)
Azithromycin
All others inhibit p450 - inc. toxicity of drug in body

40
Q

Macrolides A/E (specifically erythromycin)?

A

GI: Hepatotoxic, Heartburn, Flatulence, N/V & Diarrhea
CV: Prolonged QT interval
Thrombophlebitis, hearing loss, and (pyloric stenosis in infants)

41
Q

Can macrolides (specifically erythromycin) cross placenta and CSF?

A

Placenta - yes

CSF - no

42
Q

Azithromycin A/E?

A

Sun sensitivity and diarrhea

43
Q

Which two macrolides have similar A/E?

A

Erythromycin & Clarithromycin

44
Q

Tetracylines has ability to bind with metallic ions and form insoluble compounds. Therefore avoid taking ____ when on this medication

A

Antacids

45
Q

What is name of tetracyclines? (suffix)

What is MOA?

A

-cyclines

Inhibit bacterial protein synthesis (30s ribosome)

46
Q

3 antibiotic classes contraindicated in pregnancy?

A 
Tetracycline
Sulfonamides
Quinolones
Flagyl
Chloramphenicol
47
Q

Which drug in tetracycline class to give in pt with SIADH (syndrome of inappropriate anti-diuretic hormone)?

A

Demeclocycline - inhibits ADH

48
Q

Can tetracyclines penetrate BBB & CSF?

A

Yes - specifically minocycline and doxycycline

49
Q

All other tetracyclines have reduced absorption when taken with food except?

A

Minocycline

50
Q

Avoid these items when on tetracyclines

A

Iron, calcium products, Magnesium & aluminum (laxatives/Antacids), Zinc
Can decrease efffectiveness of OCP

51
Q

Unique A/E of tetracyclines?

A 
Teeth discoloration
Photosensitivity Rxn
Yeast Infection
Exacerbation of Lupus
Buldging Fontanelles
Thrombocytopenia/anemia
52
Q

What are names of the quinolones? (suffix)

MOA?

A

-floxacin

destroy bacteria by altering bacteria DNA

53
Q

Unique A/E of quinolones?

A

Black Box Warning: ruptured tendons & tendonitis
CNS: Altered mental status, convulsions, depression, dizziness
GI: N/V Flautulence, Heartburn, Diarrhea, oral candidiasis
CV: prolonged QT interval
Skin: Rash, Pruritis, Flushing, Urticaria - Photosensitive

54
Q

Quinolone interaction with dairy products, antacids and other metallic ions, and probenecid?

A

Dairy, Antacids, and metallic ions - Reduce asorption

Probenecid - Reduce excretion

55
Q

What is probenecid?

A

Renal Tubular Transport Blocking Agent

56
Q

Name of sulfonamides? (pre-fix)

MOA?

A

Sulfa

Prevents bacteria synthesis of folic acid –inhibiting growth (bacteriostatic)

57
Q

If patient has known sulfa allergy, do not give drugs of this class

A

COX 2 Inhibitors

58
Q

Sulfa drug-drug interactions with warfarin and phenytoin

A

Warfarin - inc. risk of bleeding

Phenytoin - Inc. toxicity

59
Q

Unique Sulfa A/E

A 
Steven Johnson Syndrome
Kernicterus (Neurotoxic) - bilirubin deposition in brain of newborns
Convulsion
Anemia/Thrombocytopenia
Photosensitivity Rxn
Delayed skin Rash & pancreatitis
60
Q

Which class of antibiotics to avoid if pt has G6PD deficiency?

A

Sulfonamides

61
Q

Oral anticoagulants (warfarin) taken with ______ can prolong INR leading to bleeding

A

Quinolone

62
Q

DOC for MRSA and severe C.Diff?

A

Vancomycin

63
Q

A/E of Vancomycin?

A

Red Man Syndrome - flushing/itching of head and neck, hypotension; all from rapid IV infusion
Ototoxicity (may be permanent or reversible)
Nephrotoxicity

64
Q

MOA of Vancomycin

A

Destroys bacterial cell wall

65
Q

How long should vancomycin be infused if given IV?

A

over 60 minutes

66
Q

Clindamycin MOA?

A

inhibits protein synthesis - normally bacteriostatic but @ high doses it is bactericidal

67
Q

Unique A/E of clindamycin?

A

Steven Johnson - first appears as flu like symptomes then develops into painful rashes, blisters, and eye redness
EKG Changes - caused by rapid IV infusion
C.Diff!!

68
Q

What is C.Diff?

Which antibiotic can cause C.Diff?

A

normally harmless microflora in GI; external stimulus upsets gut causing abnormal overgrowth and release of toxins attacking the lining of intestines (Pseudomembranous colitis)
Clindamycin

69
Q

Which drug is used against multi-drug resistant gram positive pathogens? (eg Vancomycin resistent enterococci and Methicillin resistant staphylococcus aureus)

A

Linezolid

70
Q

Which drug is used as prophylaxis in abdominal surgery, vaginal surgery, and colorectal surgery?

A

Metronidiazole (Flagyl) - also used in protozoal infections and for C diff

71
Q

Which drug can cause fatal aplastic anemia and grey baby syndrome(vomiting, abd distension, cyanosis, grey skin discoloration)?
Why use this drug?

A

Chloramphenicol

Used only for life-threatening infections for which safer meds are ineffective

72
Q

Name three antibiotic classes that have adverse photosensitivity effect

A

Sulfonamides, tetracyclines, quinolones

73
Q

Which antibiotic class should be taken with food and can cause antabuse-like rxn when taken with alcohol?

A

Cephalosporins

74
Q

This antibiotic may produce red/brown urine

A

Flagyl

Pharm (5 decks)

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