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Pharmacology Step 1 > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Penicillin G/V; MOA, use, AE

A

G = IV; V = oral
MOA - 1. bind penicillin0binding proteins (transpeptidases, involved in synthesis of the cell walls)
2. block transpeptidase cross-linking of peptidoglycan in cell wall
3. activate autolytic enzymes -> remodels cell wall
Use - mostly gram (+) coverage (S. pneumo, S. progenies, Actinomyces, group B strep, Clostridium, Listeria, Bacillus); gram (-) coverage (mainly N. meningitides) and spirochetes (T. pallidum)
AE - hypersensitivity reactions, hemolytic anemia

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2
Q

Penicillinase-sensitive penicillins; name, MOA, use, AE

A

Amoxicillin, ampicillin, aminopenicillin
MOA: same as penicillin
Use: extended spectrum penicillin - cover HEELPSS organisms: H. flu, E. coli, Enterococci, Listeria, Proteus mirabilis, Shigella, Salmonella
AE: hypersensitivity reactions, rash with mononucleosis

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3
Q

Penicillin-resistant penicillins; name, MOA, use, AE

A

Dicloxacillin, nafcillin, oxacillin, methicillin (can cause interstitial nephritis, so not used)
MOA: same as penicillin; penicillinase-resistant d/t large R group
Use: S. aureus (except MRSA)
AE: hypersensitivity reactions

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4
Q

Antipseudomonal penicillins; name, MOA, use, AE

A

piperacillin, ticeracillin, carbenicillin
MOA: same as penicillin
Use: pseudomonas spp. and gram (-) rods; susceptible to penicillinase
AE: hypersensitivity

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5
Q

beta lactase inhibitors; name, MOA, use

A 
Clavulanic acid (use with amoxicillin, esp for otitis media), Sulbatam (use with ampicillin), Tazobactam (use with ticarcillin + piperacillin)
MOA - protect antibiotic from destruction by beta-lactamase (penicillinase)
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6
Q

What are the organisms typically not covered by cephalosporins generation 1-4?

A

Organisms not covered by 1st-4th generation cephalosporins are LAME
Listeria
Atypicals (Chlamydia, Mycoplasma), MRSA, Enterococci

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7
Q

What is the MOA of all cephalosporins?

A

beta lactic drugs that inhibit cell wall synthesis (less susceptible to penicillinases)

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8
Q

1st generation cephalosporins: names, coverage, use

A

cefazolin, cefalexin
Coverage: gram + cocci, and PEcK - Proteus mirabilis, E. coli, Klebsiella
Use: UTIs, URIs, prophylaxis to S. viridian’s endocarditis (amoxicillin still 1st line), cephazolin used before surgery to prevent S. aureus wound infections)

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9
Q

2nd generation cephalosporins: names, coverage, use

A

cefprozil, cefaclor, cefoxitin, cefuroxime (pro fake fox fur)
Coverage: gram + cocci, HENS PEcK: H. influ, Enterobacter aerogenes, Neisseria spp., Serratia, Proteus mirabilis, E. coli, Klebsiella
Use - do not use to treat gonnorhea

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10
Q

3rd generation cephalosporins: names, coverage, use

A

ceftriazone, cefotaxime, ceftazidime, cefdinir
Coverage: S. pneumo, serious gram - infections resistant to other beta-lactams
Use: ceftriaxone - meningitis, gonorrhea (drug of choice for gram - meningitis; good to use in renal failure), disseminated Lyme disease
ceftazidine - pseudomonas
cefdinir - resistant causes of otitis media (1st line amoxicillin)

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11
Q

4th generation cephalosporins: names, coverage

A

cefepime

Coverage: gram (-) organisms with increased activity against pseudomonas and gram (+) organisms

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12
Q

5th generation cephalosporins: names, coverage, use

A

ceftaroline
Coverage: broad gram + and gram - organisms coverage
Unlink 1st-4th gen, has coverage against: Listeria, MRSA, and Enterococcus faecalis
Does not cover pseudomonas

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13
Q

What are the common AE of cephalosporins?

A

hypersensitivity reactions, disulfiram-like reaction, increased nephrotoxicity of ahminoglycosides

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14
Q

Aztreonam MOA, use, AE

A

MOA - prevents peptidoglycan cross-linking by binding to penicillin-binding protein 3; synergistic with ahminoglycosides; no cross-allergy with penicillins
Use - gram (-) rods only (E. coli, Klebsiella, Pseudomonas, Serratia); no activity against gram + rods or anaerobes; use in pts with penicillin allergy or those with renal insufficiency that cannot tolerate aminoglycosides
AE - well tolerated

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15
Q

Carbapenems - names, MOA, use, AE

A

Names - imipenem (with cisplatin), meropenem, ertapenem, doripenem
MOA - bind to penicillin binding proteins
Use - wide coverage; gram + cocci, gram - rods, and anaerobes; pseudomonas coverage but NOT MRSA
AE - GI distress, skin rash, seizures (merepenem has decreased risk of seizures)

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16
Q

Why is imipenem always administered with cisplatin?

A

cisplatin inhibits dehydropeptidase I in the kidneys, which inactivates imipenem in the renal tubules

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17
Q

Vancomycin MOA, use, AE

A

MOA - binds to D-ala D-ala portion of cell wall precursors -> inhibits cell wall mucopeptide formation -> inhibits cell wall glycopeptide polymerization
Use - gram + bugs only, used for coag-neg staph endocarditis; MRS, S. epidermidis, sensitive Enerococcus species, and C. diff (oral dose for pseudomembranous colitis)
AE - NOT trouble free - nephrotoxicity, ototoxicity, thrombophlebitis; Red man syndrome - d/t nonspecific mast cell degranulation

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18
Q

How does an organism develop resistance to vancomycin?

A

amino acid modification of D-Ala D-Ala to D-Ala D-Lac

19
Q

A patient is receiving an IV infusion of an antibiotic and the nurse calls you when his face becomes flushed 15 minutes after the infusion started. What is the treatment for this patient?

A
  • stop the infusion of vancomyin
  • pretreat with antihistamines
  • start the infusion again but slower
20
Q

Linezolid MOA, use, AE

A

MOA - binds 23S RNA on 50S subunit and inhibits initiation
Use - MRSA, VRE
AE - serotonin syndrome

21
Q

Which antibiotics are 30S inhibitors and which are 50S inhibitors?

A

Buy AT 30, CCEL (sell) at 50
30S - Aminoglycosides, Tetracyclines
50S - Chloramphenicol, Clindamycin, Erythromycin (macrolides), Linezolid

22
Q

Tetracyclines names, MOA, Use, AE

A 
Names - tetracycline, doxycycline, minonycline, demeclocycline
MOA - bind to 30S subunit and prevent attachment of tRNA; doxycycline can be used in renal failure; cannot take tetracyclines with milk or antacids
Use - VACUUM THe BedRoom
- vibrio cholera
- acne
- chlamydia
- ureaplasma urealyticum
- mycoplasma pneumonia
- tularemia
- H. pylori
- Borrelia burgdorferi
- Ricketssia
AE - discoloration of teeth and inhibition of bone growth in children, photosensitivity, C/I in pregnancy
23
Q

Aminoglycosides names, MOA, Use, AE

A

Names - gentamicin, neomycin, amikacin, tobramycin, streptomycin
MOA - irreversible inhibition of initiation complex by binding 30S subunit; require O2 for uptake (ineffective against anaerobes)
Use - gram - rods; synergistic with beta-lactam Abs; neomycin can be used for bowel surgery
AE - nephrotoxic, ototoxic (esp with loop diuretics), teratogenic (NOT)

24
Q

Macrocodes names, MOA, Use, AE

A

Names - azithromycin, clarithromycin, erythromycin
MOA - bind 23S rRNA of the 50S ribosomal subunit -> inhibit protein synthesis by blocking translation
Use - PUS
- pneumonia (atypical) - mycoplasma, chlamoydophila, legionella
-URI (S. progenies, H. influ)
-STD (chlamydia, gonnorhea)
AE - QT prolongation, acute cholestatic hepatitis (erythromycin), eosinophila, increase serum concentration of theophylline and oral anticoagulants (warfarin)

25
Q

Are macrocodes safe to use in pregnancy?

A

Yes, especially azithromycin

26
Q

Chloramphenicol MOA, Use, AE

A

MOA - blocks peptidyltransferase at the 50S ribosomal subunit
Use - meningitis (H. influ, N. meningitidis, S.pneumo)
AE - anemia, aplastic anemia, gray baby syndrome (in premature infants because they lack liver UDP glucuronyltransferase, which is necessary to break down the drug)

27
Q

Clindamycin MOA, Use, AE

A

MOA - blocks peptide transfer (translocation) at the 50S ribosomal subunit
Use - anaerobic infections (Bacteroides and Clostridium); good for MRSA skin infections, protozoal infection, and acne
AE - pseudomembranous colitis (C. difficile)

28
Q

Streptogramins Names, MOA, Use, AE

A

Names - quinupristin/Dalfopristin
MOA - bind to the 23S portion of the 50S ribosome
Use - MRSA< VRE, staph and strep skin infections
AE - hepatotoxicity, pseudomembranous colitis, arthralgia and myalgia

29
Q

Glycylcyclines names, MOA, Use, AE

A

Name - tigecycline
MOA - binds to 30S, inhibiting protein synthesis
Use - broad spectrum anaerobic gram - and gram + coverage; MRSA, VRE
AE - GI Sx

30
Q

What causes gray baby syndrome? Gray man? Red man?

A

Gray baby - chloramphenicol
Gray man - amiodarone
Red man - vancomycin

31
Q

Sulfonamides Names, MOA, Use, AE

A

names - sulfamethoxazole (SMX), and others
MOA - inhibit dihydropteroate synthase, inhibiting folate synthesis
Use - gram +, gram -, nocardia; SMX for simple UTI
AE - hypersensitivity, hemolysis in G6PD deficiency, nephrotoxicity, photosensitivity, Stevens-Johnson syndrome, kernicterus in infants, displace warfarin from albumin

32
Q

Trimethoprim MOA, Use, AE

A

MOA - inhibits bacterial dihydrofolate reductase
Use - always combined with SMX; UTIs, shigella, salmonella, pneumocystis jiroveci
AE - megaloblastic anemia, leukopenia, granulocytopenia

33
Q

Nitrofurantoin MOA, Use, AE

A

MOA - reduced by bacteria to a reactive intermediate that inactivates bacterial ribosomes
Use - UTI cystitis by E. coli or Staph saprophyticus
AE - nothing much; can be used in pregnancy

34
Q

Fluoroquinolones Names, MOA, Use, AE

A

Names - ciprofloxacin, norfloxacin, levofloxacin, moxifloxacin, nalidixic acid
MOA - inhibit DNA gyrase (topoisomerase II); must not be taken with antacids
Use - gram - rods of urinary and GI tracts (including Pseudomonas)
AE - C.I in pregnancy women, nursing moms, and children under 18 due to cartilage damage; can prolong QT interval; can cause tendonitis or tendon rupture in elderly; ciprofloxacin inhibits cytP450

35
Q

Metronidazole MOA, Use, AE

A

MOA - forms toxic free radicals that damage DNA
Use - GET GAP on the Metro
Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, anaerobes (bacteroides, Clostridium), H. Pylori
AE - disulfiram-like reaction

36
Q

Polymyxins B & E MOA, Use, AE

A

MOA - cationic detergents -> disrupt cell membranes
Use - last resort for gram - infections; topical in OTC ointments (Neosporin)
AE - neurotoxic and nephrotoxic

37
Q

What agent is used for prophylaxis against gonorrhea?

A

ceftriaxone

38
Q

What agent is used for prophylaxis against syphilis?

A

penicillin G

39
Q

What agent is used for prophylaxis against recurrent UTIs?

A

TMP-SMX

40
Q

What agent is used for prophylaxis against pneumocystis jirovecii pneumonia?

A

TMP-SMX

41
Q

What agent is used for prophylaxis in exposure to H. influenza type B meningitis?

A

Rifampin

42
Q

What agent is used for prophylaxis in a patient with a mechanical heart valve to prevent endocarditis?

A

amoxicillin

43
Q

When should TMP-SMX be started for prophylaxis against pneumocystis jirovecii in patients with HIV?

A

CD4 < 200

Pharmacology Step 1 (8 decks)

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