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Pharmacology > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Families of Beta Lactams

A
  1. Penicillins
  2. Cephalosporins
  3. Carbapenems
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2
Q

Classes of Antibiotics

A
  1. Beta Lactams
  2. Glycopeptides
  3. Fluoroquinolones
  4. Aminoglycosides
  5. Lincosamides
  6. Tetracyclines
  7. Macrolides
  8. Oxazolidinones
  9. Sulfonamides
  10. Metronidazole
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3
Q

Beta-lactams MOA

A

bind to penicillin binding proteins, interfere with cell wall synthesis

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4
Q

What is beta lactamase?

A

an enzyme produced by all Gram negative bacteria which hydrolyzes B-lactam ring of penicillins and cephalosporins and destroys their antibiotic activity

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5
Q

How do beta lactamase inhibitors work?

A

they bind beta lactamase and improve spectrum of antibiotic

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6
Q

Examples of beta lactamase inhibitors

A
  1. clavulanic acid (added to amoxicillin)

2. tazobactam (added to piperacillin)

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7
Q

Categories of Penicillins

A
  1. Narrow-spectrum
  2. Aminopenicillins - greater gram negative coverage
  3. Broad spectrum - often with beta lactamase inhibitor
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8
Q

Mechanisms of Resistance to Penicillins

A
  1. Presence of lipopolysaccharide outer layer
  2. variations in penicillin binding protein –> decreased binding of beta lactam
  3. Production of beta lactamase
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9
Q

Clearance of penicillins

A

80% cleared by kidneys w/in 4 hours

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10
Q

Contraindications of penicillins

A

Renal dysfunction - must adjust dose

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11
Q

Examples of penicillins

A
  1. Penicillin G (IV)
  2. Penicillin V (PO) aka Penicillin VK
  3. Amoxicillin (Amoxil, Trimox) - aminopenicillin
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12
Q

If you give a pt amoxicillin and they develop a flat, itchy rash, what should you consider?

A

Mono

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13
Q

Side Effects of Penicillins

A
  1. Hypersensitivity (mild rash to anaphylaxis)
  2. Nausea/Vomiting
  3. Diarrhea
  4. Stinging w/ IV
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14
Q

If pt has allergic reaction to penicillin, how would you handle other beta-lactams?

A

OK with mild reactions, but do not prescribe if they had severe hypersensitivity OR had mild reaction but also has pulmonary issues

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15
Q

What kinds of bacteria would you prescribe penicillins for?

A
  1. Very good for Gram +
  2. Animopenicillins and broad spectrum good for Gram -
  3. Broad spectrum very good for anaerobes
  4. Broad spectrum good for pseudomonas
  5. IV Penicillin G good for Neisseria meningitidis
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16
Q

What can you use to treat Neisseria meningitidis?

A

IV Penicillin G

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17
Q

How many generations of Cephalosporins are there? What is the significance of the generations?

A

4

As you move up generations, coverage expands.

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18
Q

Example of 1st generation cephalosporin

A

Cephalexin/Keflex

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19
Q

Example of 2nd generation cephalosporin

A

Cefaclor/ceclor

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20
Q

Example of 3rd generation cephalosporins

A

Ceftriaxone/Rocephin

Cefdinir/Omnicef

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21
Q

What is a good antibiotic for meningitis or encephalitis and why?

A

3rd gen cephalosporins b/c they have good CNS penetration

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22
Q

Excretion of Cephalosporins

A
  1. Renal excretion so adjust dose

2. Except ceftriaxone which has liver excretion so adjust dose

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23
Q

What kinds of bacteria can you treat with cephalosporins?

A
  1. Very good (esp 1) for Gram +
  2. Gens 2&3 very good for Gram -
  3. Gens 2&3 good for anaerobes
  4. Ceftazidime and 4th gen very good for pseudomonas
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24
Q

Contraindications of Cephalosporins

A
  1. Anaphylaxis to penicillins!!!!

2. Nonanaphylactic allergy is relative contraindication, cross reactivity is 2-10%

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25
Q

Side Effects of Cephalosporins

A
  1. Low WBC
  2. Nephrotoxicity
  3. C. diff (pseudomembranous colitis)
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26
Q

What is a good antibiotic choice for skin infections?

A

1st gen cephalosporins

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27
Q

What is a good prophylactic antibiotic prior to surgery?

A

1st gen cephalosporins

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28
Q

What would you prescribe for an intra-abdominal infection?

A

2nd gen cephalosporin

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29
Q

2nd gen cephalosporins good for

A
  1. intra-abdominal infections

2. OK for mild infections predicted to be due to Gram - bacteria

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30
Q

What are 1st gen cephalosporins good for?

A
  1. Skin infections

2. Prophylaxis prior to surgery

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31
Q

What are 3rd generation cephalosporins good for?

A

severe infections in combination with another drug of a different class

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32
Q

What are 4th gen cephalosporins good for?

A

severe hospital facility acquired infections

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33
Q

What is unique about carbapenems?

A

only IV, “big gun” for severe infections

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34
Q

Excretion of Carbapenems

A

kidney - adjust dose

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35
Q

What kinds of bacteria are carbapenems good for?

A

very good for Gram + and - bacteria, anaerobes, pseudomonas, SPACEs, ESBL (very good coverage)

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36
Q

Indication for carbapenems

A

Severe infections, suspected resistant organisms

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37
Q

Contraindications for carbapenems

A

imipenem causes seizures

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38
Q

Side effects of carbapenems

A

Nausea/vomiting, neurotoxicity (seizure, lightheadedness, dizziness), fever

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39
Q

Examples of glycopeptides

A

vancomycin/vancocin

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40
Q

Glycopeptide MOA, bactericidal or static?

A

inhibit cell wall synthesis, bactericidal

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41
Q

Mechanism of Resistance against Glycopeptides

A
  1. variation in amino acid precursor so that drug cannot bind
  2. excess cell was production
  3. biofilm production
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42
Q

What is the half life of vancomycin?

A

6 hours

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43
Q

How are glycopeptides administered?

A
  1. PO if infection in GI tract (C. diff)

2. IV or IM if infection outside GI tract

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44
Q

Clearance of Glycopeptides

A

kidney –> adjust dose

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45
Q

What kinds of bacteria are glycopeptides used for?

A
  1. very good for Gram +
  2. very good for MRSA
  3. Good for C. diff and enterococcus
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46
Q

Contraindications for glycopeptides

A

any ototoxic medications

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47
Q

Side effects of glycopeptides

A
  1. IV causes histamine release –> drop in BP and flushing
  2. Ototoxicity if administered with another ototoxic agent (ie. loop . diuretic)
  3. Nephrotoxicity if administered with another nepthrotoxic agent
  4. Neutropenia in immunocompromised pt
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48
Q

If you want to prescribe a glycopeptide, what do you need to check the patient’s med list for?

A

ototoxic medication ie. loop diuretic, aminoglycoside

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49
Q

Examples of Fluoroquinolones

A
  1. Ciprofloxavin/Cipro
  2. Levofloxacin/Levaquin
  3. Moxifloxacin/Avelox
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50
Q

Fluoroquinolones MOA, bactericidal or static?

A

inhibits DNA replication and transcription, bactericidal

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51
Q

Mechanisms of Resistance - Fluoroquinolones

A
  1. Mutations in topoisomerase (target)

2. Altered pumps that actively pump drug out of cell

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52
Q

Absorption of Fluoroquinolones

A

absorbed very well from gut, easy transition from IV to PO

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53
Q

Clearance of fluoroquinolones

A
  1. Most via kidney –> adjust dose

2. Moxifloxacin via liver –> adjust dose

54
Q

What kinds of bacteria are fluoroquinolones effective against?

A
  1. good for Gram +
  2. very good for Gram -
  3. Levofloxacin and moxifloxacin are good for anaerobes
  4. good for chlamydia
  5. good for mycobacterium avium
55
Q

What speciality are fluoroquinolones most used in?

A

Urology

56
Q

Fluoroquinolones are a good back up for _____

A

macrolides

57
Q

Contraindications for fluoroquinolones

A
  1. Pregnancy!!!!
  2. Children!!!
  3. NSAIDs so need to stop these temporarily (otherwise dizziness, lightheadedness, seizures)
58
Q

Side Effects of Fluoroquinolones

A
  1. Generally well tolerated
  2. Nausea/Vomiting
  3. Diarrhea
  4. Tendon ruptures (rare)
59
Q

Examples of Aminoglycosides

A

Gentramicin

60
Q

Where do you seen aminoglycosides used the most?

A

inpatient IV (because requires high surveillance of kidney function)

61
Q

Aminoglycosides MOA

A

inhibit protein synthesis

62
Q

Mechanisms of Resistance - Aminoglycosides

A
  1. ribosome alteration
  2. decreased permeability
  3. inactivation by aminoglycoside modifying enzymes
63
Q

Absorption of Aminoglycosides

A
  1. poorly absorbed in GI tract

2. usually IV

64
Q

Spectra of Aminoglycosides

A
  1. very good for Gram -

2. good for pseudomonas

65
Q

Contraindications for Aminoglycosides

A

Renal Dysfunction!! (May adjust dose if stage 1 but o/w don’t do it)

66
Q

What must you monitor when giving aminoglycosides?

A

Kidney function PRIOR to and THROUGHOUT therapy

67
Q

Side Effects of aminoglycosides

A
  1. Ototoxicity

2. Nephrotoxicity

68
Q

Examples of Lincosamides

A

Clindamycin

69
Q

What are lincosamides most commonly used for?

A
  1. dental infections
  2. bone infections
  3. used after macrolides if have beta-lactam allergy
70
Q

Lincosamides MOA, bactericidal or static?

A

Inhibits protein synthesis, generally bacteriostatic

71
Q

Mechanisms of Resistance - lincosamides

A
  1. mutation of ribosomal receptor site

2. enzymatic inactivation

72
Q

If a bacteria has resistance to clindamycin, what does this usually imply?

A

cross-resistance to macrolides

73
Q

Clearance of lincosamides

A

Liver –> dose adjustments

74
Q

Absorption of lincosamides

A

well absorbed orally

75
Q

Spectra of Lincosamides

A
  1. good for Gram +
  2. very good for anaerobes
  3. good for severe Gram + infection in combo w/ other bactericidal drugs
76
Q

Contraindications for Lincosamides

A

None

but remember liver metabolism

77
Q

Side effects of lincosamides

A

high incidence of C. diff

78
Q

Examples of Tetracyclines

A
  1. Tetracycline
  2. Doxycycline (oracea, doryx)
  3. Minocycline (minocin)
79
Q

What are tetracyclines commonly used for?

A

acne, Q-fever, lyme disease

80
Q

What do you prescribe for Lyme disease?

A

doxycycline

81
Q

Frequency of dosage for the 3 tetracyclines

A
  1. Doxy and mino are BID

2. Tetra is 4x/day

82
Q

Tetracyclines MOA, bactericidal or static?

A

inhibits translation, bacteriostatic

83
Q

Mechanisms of Resistance - tetracyclines

A
  1. pumped out
  2. ribosomal protection
  3. enxymatic inactivation
84
Q

What shoud you not take with tetracyclines?

A
  1. Calcium
  2. Magnesium
  3. Food
85
Q

Clearance of tetracyclines

A

kidney –> dose adjustments

86
Q

Spectra of Tetracyclines

A
  1. Good for Gram +/-

2. good for intracellular organisms (chlamydia, mycoplasma, rickettsia), spirochetes (syphilis, borreliosis), malaria

87
Q

What antibiotic is good for tick-born infection and especially considered for patients who work with cattle, sheep, goats?

A

Tetracyclines

88
Q

Contraindications for tetracyclines

A
  1. Pregnancy and Lactation

2. Children <8 yo (b/c tooth discoloration)

89
Q

Side effects of tetracyclines

A
  1. Nausea, vomiting, diarrhea
  2. Mottling of teeth
  3. photosensitivity
  4. diabetes insipidus
  5. liver damage
  6. kidney damage
  7. headache –> pseudo tumor cerebri (increased intracranial pressure)
90
Q

What do you prescribe for acne?

A

Doxycycline

91
Q

If you have a patient being treated for acne and they develop an insidious, low-grade, daily headache, what should you consider?

A

That it may be due to the tetracycline. Refer to ophthalmology to look for papilledema.

92
Q

Examples of Macrolides

A
  1. Erythromycin (ery-tab)
  2. Azithromycin (Zithromax, z-pak)
  3. Clarithromycin (Biaxin)
93
Q

What can you use to treat gastroparesis?

A

erythromycin

94
Q

When is a good time to use macrolides?

A

when patient cannot take beta-lactam

95
Q

Macrolides MOA, bactericidal or static?

A

inhibits protein synthesis (translation), generally bacteriostatic

96
Q

What other effect dose erythromycin have?

A

stimulates motilin receptors on GI smooth muscles, increases transit of GI contents, can cause diarrhea

97
Q

Mechanism of resistance - Macrolides

A
  1. pumped out
  2. esterase hydrolyzes macrolides
  3. complete cross resistance (if resistant to one, resistant to whole class)
98
Q

Half life and dosing for azithromycin

A

“long half life”

double dose the first day (250mg BID), then 250mg QD for 2-5 days

99
Q

Metabolism of macrolides

A

liver

100
Q

Drug interactions with macrolides

A

liver metabolized drugs ie. STATINS (must hold)

101
Q

Common side effect of clarithromycin

A

metallic taste in mouth

102
Q

Spectra of Macrolides

A
  1. Very good for Gram +/-

2. good for atypical bacteria (rickettsia, chlamydia, legionella, gonorrhea)

103
Q

What do you commonly prescribe for STI’s?

A

clarithromycin or azithromycin

104
Q

What is commonly used to treat pneumonia?

A

macrolides

105
Q

Examples of Sulfonamides

A
  1. Sulfamethoxazole

2. Silver sulfadiazine/sulfacetamide (topical)

106
Q

Example of folate synthesis inhibitor (non-sulfas)

A

Trimethoprim

107
Q

What is the name of the combination sulfa/folate synthesis inhibitor antibiotic?

A

Bactrim (Septra) - combination of sulfamethazole and trimethoprim

108
Q

What is commonly used to treat UTIs?

A

Bactrim

109
Q

What is commonly used for prevention of infection in HIV patients?

A

Bactrim

110
Q

Sulfonamides MOA

A

inhibit folate synthesis

111
Q

Trimethoprim MOA

A

inhibit folate synthesis at different step than sulfas

112
Q

Mechanism of resistance to sulfonamides

A
  1. overproduction of PABA
  2. Enzyme mutation that leads to reduced affinity for binding sulfas
  3. pumped out
113
Q

How are sulfas administered?

A
  1. PO, always w/ trimethoprim

2. topical for burns

114
Q

Metabolism of sulfonamides

A

Metabolized by liver and excreted by kidney –> dose adjustments for patients with advance renal dysfunction

115
Q

Spectra of Sulfa and other

A
  1. good for Gram +/-

2. good for PJP (pneumocystic jiroveci) which is an opportunistic infection seen in HIV patients

116
Q

Side effects of sulfonamides

A
  1. Steven-Johnson syndrome
  2. Hemolytic anemia, aplastic anemia, granulocytopenia, thrombocytopenia
  3. kernicterus (high bilirubin)
117
Q

Contraindications for sulfonamides

A
  1. allergy to sulfa antibiotics

2. G6PD deficiency

118
Q

What is Steven-Johnson syndrome?

A

A rare but life-threatening hypersensitivity that causes skin to start peeling/sloughing off.

119
Q

If a patient had any reported skin or mucous membrane reactions, what would you be cautious prescribing and why?

A

Sulfonamides because they can cause Steven-Johnson syndrome

120
Q

Common uses for sulfonamides

A

UTIs, URIs, PJP prophylaxis

Topical sulfa to prevent infection secondary to burn

121
Q

What is commonly used to treat respiratory infections?

A

Bactrim

122
Q

Examples of Metronidazole

A

Metronidazole/Flagyl

123
Q

Is metronidazole bactericidal or static?

A

Cidal

124
Q

What does metronidazole work against?

A

protozoa (trichomonas, giardia, entamoeba), anaerobic bacteria, C. diff

125
Q

Route of administration of metronidazole

A

PO, good absorption

126
Q

Metabolism of Metronidazole

A

Liver –> dose adjustment

127
Q

What is metronidazole used to treat?

A

bacterial vaginosis
giardia
C. diff if cannot take vancomycin

128
Q

What is first line treatment for C. diff?

A

vancomycin

129
Q

Side effects of metronidazole

A

Nausea, metallic taste, rarely CNS toxicity, neutropenia, pancreatitis, peripheral neuropathy, hepatitis

130
Q

Contraindications for Metronidazole

A
  1. Cannot be taken with alcohol!! (will have severe nausea/vomiting)
  2. Pregnancy
131
Q

What is the Disulfiram reaction?

A

Build up of acetaldehyde causing severe nausea, vomiting. Seen in antabuse which is used for recovering alcoholics

132
Q

When do you have to worry about the disulfiram reaction?

A

When patients mix Metronidazole with alcohol

Pharmacology (27 decks)

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