Antibiotics

Question 1

Primaxin: Gorillamycin
What is it?
MOA?
Coverage?
Doseage?

Risk:

Answer 1

• Imipenem and cilastatin (inhibits dehydropeptidase)
• bind PCN binding proteins inhibiting cell wall synthesis
• Coverage: very broad spectrum of activity, serious systemic infections, for use with very resistant bugs

500mg IV q6h

High risk of seizures

Question 2

Meropenem
What is it?
MOA?
Coverage?
Doseage?

Answer 2

• A carbapenem
• binds PCN binding proteins to inhibit cell wall synthesis
• Coverage: strep, pseudomonas, bacteroides
• 500mg IV q8: 1g IV q8

Question 3

Invanz
What is it?
MOA?
Coverage?
Doseage?

Answer 3

Ertapenem

• binds PCN binding proteins to inhibit cell wall synthesis
• Coverage: MSSA, Strep, Aerobes. Used for moderate-severe foot infections

DOES NOT COVER PSEUDO

Dose: 1g IM/IV qday

Question 4

Gentamicin
What is it?
MOA?
Coverage?
Doseage?

Side effects?

Answer 4

an Aminoglycoside

• Protein synthesis inhibitor, binds irreversibly to 30S
• Covers: serratia
• Dose: 1-1.7mg/kg IM/IV q8

Side effects: ototoxicity, nephrotoxicity

Question 5

Tobramycin
What is it?
MOA?
Coverage?
Doseage?

Answer 5

an aminoglycoside

• Protein synthesis inhibitor, binds irreversibly to 30S
• Covers pseduo aeruginosa

Dose: 1-1.7mg/kg IM/IV q8

Side effects: ototoxicity, and nephrotoxicity

Question 6

Amikacin
What is it?
MOA?
Coverage?
Doseage?

Answer 6

An aminoglycoside

• protein synthesis inhibitor, binds irreversibly to 30S
• reserved for organisms resistant to gentamycin and tobramycin

Dose: 7.5 mg/kg IM/IV q12h

Side effects: ototoxicity and nephrotoxicity

Question 7

Penicillin G

• MOA
• Coverage
• Doseage

Answer 7

MOA: acts on penicillin binding protein to inhibit cell wall synthesis

-Coverage: anaerobes, Strep, nonpenicillinase staph, nonpenicillinase gonococci

Dose: 1.2-40million units IM or IV qd

Question 8

Penicllin V

• MOA
• Coverage
• Doseage

Answer 8

acts on penicillin binding protein to inhibit cell wall synthesis

Coverage: anaerobes, strep, nonpenicillinase staph, and nonpenicillinase gonococci

Dose: 250-500 mg po qd

Question 9

Ampicillin

• MOA
• Coverage
• Doseage

Answer 9

acts on penicillin binding protein to inhibit cell wall synthesis

-coverage: E.coli, P.mirabilis, Shigella , Salmonella, bacteroides, enterococci

Dose: 250-1000mg PO, IM, IV q4-6

COverage

Question 10

Amoxicillin

• MOA
• Coverage
• Doseage

Answer 10

MOA: acts on penicillin binding protein to inhibit cell wall synthesis

Coverage: E.coli, P.mirabilis, Shigella, Salmonella, bacteroides, enterococci

Dose: 250-500mg PO TID

Question 11

Dicloxacillin/Cloxacillin

• MOA
• Coverage
• Doseage

Answer 11

MOA: acts on penicillin binding protein to inhibit cell wall synthesis

Coverage: DOC for MSSA

Dose: 250-500mg po bid/qid oral

Question 12

Nafcillin

• MOA
• Coverage
• Doseage

Answer 12

MOA: acts on penicillin binding protein to inhibit cell wall synthesis

Coverage: DOC for MSSA

Dose 1-2grams IV q4-q6

Question 13

Oxacillin (Bactocill)

• MOA
• Coverage
• Doseage

Answer 13

MOA: acts on penicillin binding protein to inhibit cell wall synthesis

• Dose: 250-500mg IV/IM q4-6

Question 14

Timentin

• Makeup
• MOA
• Coverage
• Doseage

What to look out for?

Answer 14

Ticarcillin/clavulonic acid

MOA: acts on penicillin binding protein to inhibit cell wall synthesis

Coverage: covers pseudo

Dose: 3.1gm IV q4-6

Watch for increased NA levels

Question 15

Zosyn

• Makeup
• MOA
• Coverage
• Doseage

Answer 15

Piperacillin/tazobactam

MOA: acts on penicillin binding protein to inhibit cell wall synthesis

Coverage: covers pseudo

Dose: 3.375-4.5 grams IV q8

Question 16

Unasyn

• Makeup
• MOA
• Coverage
• Doseage

Answer 16

ampicillin/sulbactam

MOA: acts on penicillin binding protein to inhibit cell wall synthesis

Indicated for polymicrobial diabetic foot infections

Dose: 1/5-3.0 grams IV q6

DOC MSSA

Question 17

Augmentin

• Makeup
• MOA
• Coverage
• Doseage

Answer 17

amoxicillin/clavulonic acid

MOA: acts on penicillin binding protein to inhibit cell wall synthesis

COverage: gram+ and bacteroides

Dose: 875 gm oral BID

Question 18

Which Penicillins are hepatically cleared (4)

Answer 18

Mezlocillin, Azlocillin, Nafcillin, Piperacillin

Question 19

First generation Cephalosporins (3)

Answer 19

Cephalexin, Cefadroxil, Cefazolin

Question 20

Cephalexin
Brand name 
MOA
Coverage
Doseage

Answer 20

Keflex

MOA: acts on penicillin binding proteins to inhibit cell wall synthesis

Covers: more Gram +
DOC for staph

Dose: 250mg-500mg PO BID

Question 21

Cefadroxil
Brand name 
MOA
Coverage
Doseage

Answer 21

Duricef

MOA: acts on penicillin binding proteins to inhibit cell wall synthesis

Coverage: more Gram +
DOC for staph

Dose: 30mg/kg/day PO BID

Question 22

Cefazolin
Brand name 
MOA
Coverage
Doseage

Answer 22

Ancef

MOA: acts on penicillin binding proteins to inhibit cell wall synthesis

Coverage: more Gram +
DOC for staph

Dose 2 grams IV prior to surgery

Question 23

Second generation cephalosporins (2)

Answer 23

Cefaclor, and Cefuroxime

Question 24

Cefaclor
Brand name 
MOA
Coverage
Doseage

Answer 24

Ceclor

MOA: acts on penicillin binding proteins to inhibit cell wall synthesis

Coverage: similar Gram + as 1st generation.
More upper resp coverage

Dose:250-500mg PO q8

Question 25

``` Cefuroxime Brand name MOA Coverage Doseage ```

Answer 25

Ceftin MOA: acts on penicillin binding proteins to inhibit cell wall synthesis Coverage: simmilar Gram + as 1st generation. More upper resp coverage Dose: 250-500mg PO BID

Question 26

Third generation Cephalosporins (3)

Answer 26

Ceftriaxone, ceftazidime, cefdinir

Question 27

``` Ceftriaxone Brand name MOA Coverage Doseage ```

Answer 27

Rocephin MOA: acts on penicillin binding proteins to inhibit cell wall synthesis Coverage: less gram + than previous gen. But now more gram negative. Empiric/ DOC for neisseria-septic joint Dose: 1-2grams IV q day

Question 28

``` Ceftazidime Brand name MOA Coverage Doseage ```

Answer 28

Fortaz MOA: acts on penicillin binding proteins to inhibit cell wall synthesis. Coverage: less gram + than previous generations but now more gram -. COVERS PSEUDO Dose: 1gram IV/IM BID

Question 29

``` Cefdinir Brand name MOA Coverage Doseage ```

Answer 29

Omnicef MOA: acts on penicillin binding proteins to inhibit cell wall synthesis Coverage: less gram + than previous generations but now more gram -. USED BY internal med Dose: 300mg PO BID

Question 30

Fourth gen Cephalosporin

Answer 30

Cefepime

Question 31

``` Cefepime Brand name MOA Coverage Doseage ```

Answer 31

Maxipime MOA: acts on penicillin binding proteins to inhibit cell wall synthesis Coverage: Similar Gram + to 1st gen and Gram - similar to 3rd gen. INCLUDING PSEUDO Similar coverage to zosyn Dose: 2g IV BID

Question 32

Fifth generation Cephalosporin (1)

Answer 32

Ceftaroline

Question 33

``` Ceftaroline Brand name MOA Coverage Doseage ```

Answer 33

Teflaro MOA: acts on penicillin binding proteins to inhibit cell wall synthesis Coverage: broad spectrum similar to fourth gen and active against MRSA. Dose: 600 mg IV BID

Question 34

``` Ciprofloxacin Brand name MOA Coverage Doseage ``` What to be weary of

Answer 34

Cipro MOA: inhibit bacterial DNA topoisomerase (gyrase) Coverage: Gram-. DOC-pseudo Dose:250-750mg PO BID OR 200-400mg IV BID Be careful: active people, open growth plates, supplements will decrease absorption

Question 35

``` Levofloxacin Brand name MOA Coverage Doseage ``` What to be weary of

Answer 35

Levaquin MOA: inhibit bacterial DNA topoisomerase (gyrase) Coverage: empiric antibiotic, mainly Gram- Dose: 250-500mg PO/IV Be careful: active people, open growth plates, supplements will decrease absorption.

Question 36

``` Moxifloxacin Brand name MOA Coverage Doseage ``` What to be weary of

Answer 36

Avelox MOA: inhibit bacterial DNA topoisomerase (gyrase) Coverage: empiric oral antibiotics. Covers everything but those that are resistant. Better anaerobic coverage in diabetic foot infections. Dose: 400mg qd PO Be careful: active people, open growth plates, supplements will decrease absorption.

Question 37

Macrolides (3)

Answer 37

Azithromycin, clarithromycin, erythromycin

Question 38

Erythromycin MOA Coverage: Doseage: Metabolism:

Answer 38

MOA: inhibit protein synthesis by binding to 50 S subunit Coverage: S.pyogenes, S.pneuomonia, S. aureus. Chlamydia, gonorrhoeae, syphilis. Campylobacter Dose: 250-500mg PO BID Max: 4g daily Metabolized by the liver

Question 39

Azithromycin MOA Coverage Doseage

Answer 39

MOA: inhibit protein synthesis by binding to 50s subunit. Coverage: - S.aureus - S.pyogenes - Strep agalactiae Dose: - 500mg PO day 1 - 250mg qday 2-5

Question 40

Clarithromycin Brand name MOA Coverage Doseage

Answer 40

Biaxin MOA: inhibit protein synthesis by binding to the 50s subunit. Coverage: - Staph aureus - S.pyogenes - Mycoplasma, chlamydia, mycobacteria Dose: 250mg PO BID

Question 41

Tetracyclines MOA Coverage Contraindications

Answer 41

MOA: act on 30 S subunit of bacterial ribosome inhibiting translation Coverage: broad spectrum active against community MRSA Contraindicated in pregnancy

Question 42

Clindamycin Brand name MOA: Coverage: Doseage Metabolism

Answer 42

Cleocin MOA: inhibits protein synthesis through 50s ribosome subunit Coverage: most gram positives and anaerobes. -including bacteroides fragilis Dose: --foot infections: 300-450mg tid PO --osteo due to MRSA: 600mg tid po Metabolized by liver

Question 43

Metronidazole Brand name MOA Coverage Doseage

Answer 43

flagyl MOA: binds to DNA and disrupts its structure Coverage: anaerobes (gram+ and gram-) Dose: 500mg TID PO

Question 44

Trimethoprim-sulfamethoxazole Brand name: MOA: Spectrum of activity: Dosing: Caution?

Answer 44

Bactrim MOA: inhibit bacterial synthesis of THF Spectrum of activity: aerobic G+ and G- -DOC for community acquired MRSA Dosing: -TMP/SMX: 80mg/400mg or 160mg/ 800mg Caution for people with folate deficiency

Question 45

Daptomycin Brand name : MOA: Spectrum of activity: Dosing

Answer 45

Cubicin MOA: depolarizes bacterial membranes, inhibits protein, DNA and RNA synthesis Spectrum of activity: MSSA, MRSA and VRE. DOC for MRSA infection when vanco is not allowed Dosing: Skin infections: 4mg/kg IV qday

Question 46

Tigecycline Brand name: MOA: Spectrum of activity: Dosing: Side effects

Answer 46

Tygacil MOA: binds 30s inhibiting protein synthesis Spectrum: very broad. - MRSA,MRSE, PRSP, and VRE - multi-drug resistant organisms Dose: start at 100mg IV and 50mg IV q12h Side effects: high seizure rates

Question 47

Vancomycin Brand name: MOA: Spectrum: Dosing: Peaks and troughs

Answer 47

Vancocin MOA: binds to the building blocks (NAG and NAM) of peptidoglycan to inhibit cell wall synthesis Spectrum: -DOC: for MRSA Also covers enterococcus and Strep Dosing: -Oral:125mg and 250mg -IV: 1g q12 hours (slow infusion over 1 hour) Must measure peaks and troughs with administration. (10-20mL is normal) Red man syndrome is treated with diphenhydramine

Question 48

Rifampin Brand name: MOA: Spectrum Dosing: Common Side effects

Answer 48

Rifampicin MOA: inhibition of DNA-dependent RNA polymerase leading to suppression of RNA synthesis and cell death Spectrum: - TB - Endocarditis - Hansen Disease - Anthrex Dosing: 300mg-600mg PO/IV Side effects: reddening of the mucosa. As well as urine, sweat, saliva or tears

Question 49

Linezolid Brand name MOA Spectrum of activity Dosing:

Answer 49

Zyvox MOA: binds at the P site at the ribosomal 50S subunit Spectrum: - VREF - Hospital acquired pneumonia - endocarditis - anthrax Dosin: 600mg PO/IV q12 hours

Question 50

Synercid Brand name MOA: Spectrum of activity Dosing Black box:

Answer 50

Quinupristin/dalfopristin MOA: synergistic Dalfopristin: binds to the 23 S portion of the 50S ribosomal subunit to change the conformation of it. This will enhance the binding of quinupristin by 100. Quinupristin: binds to nearby site on 50S ribosomal subunit to prevent elongation of peptide Spectrum: - MRSA - VRA/VRE Dosing: 7.5mg/kg q8h Black box for being advanced so quickly through FDA approval.