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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
Side Effects of Cephalosporins
1. Low WBC 2. Nephrotoxicity 3. C. diff (pseudomembranous colitis)
26
What is a good antibiotic choice for skin infections?
1st gen cephalosporins
27
What is a good prophylactic antibiotic prior to surgery?
1st gen cephalosporins
28
What would you prescribe for an intra-abdominal infection?
2nd gen cephalosporin
29
2nd gen cephalosporins good for
1. intra-abdominal infections | 2. OK for mild infections predicted to be due to Gram - bacteria
30
What are 1st gen cephalosporins good for?
1. Skin infections | 2. Prophylaxis prior to surgery
31
What are 3rd generation cephalosporins good for?
severe infections in combination with another drug of a different class
32
What are 4th gen cephalosporins good for?
severe hospital facility acquired infections
33
What is unique about carbapenems?
only IV, "big gun" for severe infections
34
Excretion of Carbapenems
kidney - adjust dose
35
What kinds of bacteria are carbapenems good for?
very good for Gram + and - bacteria, anaerobes, pseudomonas, SPACEs, ESBL (very good coverage)
36
Indication for carbapenems
Severe infections, suspected resistant organisms
37
Contraindications for carbapenems
imipenem causes seizures
38
Side effects of carbapenems
Nausea/vomiting, neurotoxicity (seizure, lightheadedness, dizziness), fever
39
Examples of glycopeptides
vancomycin/vancocin
40
Glycopeptide MOA, bactericidal or static?
inhibit cell wall synthesis, bactericidal
41
Mechanism of Resistance against Glycopeptides
1. variation in amino acid precursor so that drug cannot bind 2. excess cell was production 3. biofilm production
42
What is the half life of vancomycin?
6 hours
43
How are glycopeptides administered?
1. PO if infection in GI tract (C. diff) | 2. IV or IM if infection outside GI tract
44
Clearance of Glycopeptides
kidney --> adjust dose
45
What kinds of bacteria are glycopeptides used for?
1. very good for Gram + 2. very good for MRSA 3. Good for C. diff and enterococcus
46
Contraindications for glycopeptides
any ototoxic medications
47
Side effects of glycopeptides
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
48
If you want to prescribe a glycopeptide, what do you need to check the patient's med list for?
ototoxic medication ie. loop diuretic, aminoglycoside
49
Examples of Fluoroquinolones
1. Ciprofloxavin/Cipro 2. Levofloxacin/Levaquin 3. Moxifloxacin/Avelox
50
Fluoroquinolones MOA, bactericidal or static?
inhibits DNA replication and transcription, bactericidal
51
Mechanisms of Resistance - Fluoroquinolones
1. Mutations in topoisomerase (target) | 2. Altered pumps that actively pump drug out of cell
52
Absorption of Fluoroquinolones
absorbed very well from gut, easy transition from IV to PO
53
Clearance of fluoroquinolones
1. Most via kidney --> adjust dose | 2. Moxifloxacin via liver --> adjust dose
54
What kinds of bacteria are fluoroquinolones effective against?
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
What speciality are fluoroquinolones most used in?
Urology
56
Fluoroquinolones are a good back up for _____
macrolides
57
Contraindications for fluoroquinolones
1. Pregnancy!!!! 2. Children!!! 3. NSAIDs so need to stop these temporarily (otherwise dizziness, lightheadedness, seizures)
58
Side Effects of Fluoroquinolones
1. Generally well tolerated 2. Nausea/Vomiting 3. Diarrhea 4. Tendon ruptures (rare)
59
Examples of Aminoglycosides
Gentramicin
60
Where do you seen aminoglycosides used the most?
inpatient IV (because requires high surveillance of kidney function)
61
Aminoglycosides MOA
inhibit protein synthesis
62
Mechanisms of Resistance - Aminoglycosides
1. ribosome alteration 2. decreased permeability 3. inactivation by aminoglycoside modifying enzymes
63
Absorption of Aminoglycosides
1. poorly absorbed in GI tract | 2. usually IV
64
Spectra of Aminoglycosides
1. very good for Gram - | 2. good for pseudomonas
65
Contraindications for Aminoglycosides
Renal Dysfunction!! (May adjust dose if stage 1 but o/w don't do it)
66
What must you monitor when giving aminoglycosides?
Kidney function PRIOR to and THROUGHOUT therapy
67
Side Effects of aminoglycosides
1. Ototoxicity | 2. Nephrotoxicity
68
Examples of Lincosamides
Clindamycin
69
What are lincosamides most commonly used for?
1. dental infections 2. bone infections 3. used after macrolides if have beta-lactam allergy
70
Lincosamides MOA, bactericidal or static?
Inhibits protein synthesis, generally bacteriostatic
71
Mechanisms of Resistance - lincosamides
1. mutation of ribosomal receptor site | 2. enzymatic inactivation
72
If a bacteria has resistance to clindamycin, what does this usually imply?
cross-resistance to macrolides
73
Clearance of lincosamides
Liver --> dose adjustments
74
Absorption of lincosamides
well absorbed orally
75
Spectra of Lincosamides
1. good for Gram + 2. very good for anaerobes 3. good for severe Gram + infection in combo w/ other bactericidal drugs
76
Contraindications for Lincosamides
None | but remember liver metabolism
77
Side effects of lincosamides
high incidence of C. diff
78
Examples of Tetracyclines
1. Tetracycline 2. Doxycycline (oracea, doryx) 3. Minocycline (minocin)
79
What are tetracyclines commonly used for?
acne, Q-fever, lyme disease
80
What do you prescribe for Lyme disease?
doxycycline
81
Frequency of dosage for the 3 tetracyclines
1. Doxy and mino are BID | 2. Tetra is 4x/day
82
Tetracyclines MOA, bactericidal or static?
inhibits translation, bacteriostatic
83
Mechanisms of Resistance - tetracyclines
1. pumped out 2. ribosomal protection 3. enxymatic inactivation
84
What shoud you not take with tetracyclines?
1. Calcium 2. Magnesium 3. Food
85
Clearance of tetracyclines
kidney --> dose adjustments
86
Spectra of Tetracyclines
1. Good for Gram +/- | 2. good for intracellular organisms (chlamydia, mycoplasma, rickettsia), spirochetes (syphilis, borreliosis), malaria
87
What antibiotic is good for tick-born infection and especially considered for patients who work with cattle, sheep, goats?
Tetracyclines
88
Contraindications for tetracyclines
1. Pregnancy and Lactation | 2. Children <8 yo (b/c tooth discoloration)
89
Side effects of tetracyclines
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
What do you prescribe for acne?
Doxycycline
91
If you have a patient being treated for acne and they develop an insidious, low-grade, daily headache, what should you consider?
That it may be due to the tetracycline. Refer to ophthalmology to look for papilledema.
92
Examples of Macrolides
1. Erythromycin (ery-tab) 2. Azithromycin (Zithromax, z-pak) 3. Clarithromycin (Biaxin)
93
What can you use to treat gastroparesis?
erythromycin
94
When is a good time to use macrolides?
when patient cannot take beta-lactam
95
Macrolides MOA, bactericidal or static?
inhibits protein synthesis (translation), generally bacteriostatic
96
What other effect dose erythromycin have?
stimulates motilin receptors on GI smooth muscles, increases transit of GI contents, can cause diarrhea
97
Mechanism of resistance - Macrolides
1. pumped out 2. esterase hydrolyzes macrolides 3. complete cross resistance (if resistant to one, resistant to whole class)
98
Half life and dosing for azithromycin
"long half life" | double dose the first day (250mg BID), then 250mg QD for 2-5 days
99
Metabolism of macrolides
liver
100
Drug interactions with macrolides
liver metabolized drugs ie. STATINS (must hold)
101
Common side effect of clarithromycin
metallic taste in mouth
102
Spectra of Macrolides
1. Very good for Gram +/- | 2. good for atypical bacteria (rickettsia, chlamydia, legionella, gonorrhea)
103
What do you commonly prescribe for STI's?
clarithromycin or azithromycin
104
What is commonly used to treat pneumonia?
macrolides
105
Examples of Sulfonamides
1. Sulfamethoxazole | 2. Silver sulfadiazine/sulfacetamide (topical)
106
Example of folate synthesis inhibitor (non-sulfas)
Trimethoprim
107
What is the name of the combination sulfa/folate synthesis inhibitor antibiotic?
Bactrim (Septra) - combination of sulfamethazole and trimethoprim
108
What is commonly used to treat UTIs?
Bactrim
109
What is commonly used for prevention of infection in HIV patients?
Bactrim
110
Sulfonamides MOA
inhibit folate synthesis
111
Trimethoprim MOA
inhibit folate synthesis at different step than sulfas
112
Mechanism of resistance to sulfonamides
1. overproduction of PABA 2. Enzyme mutation that leads to reduced affinity for binding sulfas 3. pumped out
113
How are sulfas administered?
1. PO, always w/ trimethoprim | 2. topical for burns
114
Metabolism of sulfonamides
Metabolized by liver and excreted by kidney --> dose adjustments for patients with advance renal dysfunction
115
Spectra of Sulfa and other
1. good for Gram +/- | 2. good for PJP (pneumocystic jiroveci) which is an opportunistic infection seen in HIV patients
116
Side effects of sulfonamides
1. Steven-Johnson syndrome 2. Hemolytic anemia, aplastic anemia, granulocytopenia, thrombocytopenia 3. kernicterus (high bilirubin)
117
Contraindications for sulfonamides
1. allergy to sulfa antibiotics | 2. G6PD deficiency
118
What is Steven-Johnson syndrome?
A rare but life-threatening hypersensitivity that causes skin to start peeling/sloughing off.
119
If a patient had any reported skin or mucous membrane reactions, what would you be cautious prescribing and why?
Sulfonamides because they can cause Steven-Johnson syndrome
120
Common uses for sulfonamides
UTIs, URIs, PJP prophylaxis | Topical sulfa to prevent infection secondary to burn
121
What is commonly used to treat respiratory infections?
Bactrim
122
Examples of Metronidazole
Metronidazole/Flagyl
123
Is metronidazole bactericidal or static?
Cidal
124
What does metronidazole work against?
protozoa (trichomonas, giardia, entamoeba), anaerobic bacteria, C. diff
125
Route of administration of metronidazole
PO, good absorption
126
Metabolism of Metronidazole
Liver --> dose adjustment
127
What is metronidazole used to treat?
bacterial vaginosis giardia C. diff if cannot take vancomycin
128
What is first line treatment for C. diff?
vancomycin
129
Side effects of metronidazole
Nausea, metallic taste, rarely CNS toxicity, neutropenia, pancreatitis, peripheral neuropathy, hepatitis
130
Contraindications for Metronidazole
1. Cannot be taken with alcohol!! (will have severe nausea/vomiting) 2. Pregnancy
131
What is the Disulfiram reaction?
Build up of acetaldehyde causing severe nausea, vomiting. Seen in antabuse which is used for recovering alcoholics
132
When do you have to worry about the disulfiram reaction?
When patients mix Metronidazole with alcohol

Pharmacology (27 decks)

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