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Karboski's Pharmacology - UT AEMSN > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

What are some of the most common URI pathogens?

A
  • Streptococcus pneumoniae (+)
  • Haemophilus influenza (-)
  • Moraxella catarrhalis (-)
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2
Q

What are the fluroquinolones?

A
  • regular
    • ciprofloxacin
    • ofloxacin
  • respiratory
    • levofloxacin
    • moxifloxacin
    • gemifloxacin
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3
Q

What are the uses of natural PCNs?

A
  • Syphillis
  • Non-purulent skin infections
    • usually strep
  • Phyaryngitis
    • strep throat
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4
Q

What is prophylactic (PPX) therapy?

A
  • ABX therapy used to prevent an infxn that has Ø occurred
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5
Q

What is the spectrum of activity for the 4th gen Cephalosporin?

A
  • Gm +
    • MSSA and strep
  • Great for Gm- aerobes including:
    • P. aeruginosa
    • Enterobacter aerogenes and cloacae
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6
Q

What is the spectrum of activity for the cyclic lipopeptide?

A
  • Gm + aerobes
    • MRSA
    • vanc-resistant Enterococcus faecium
    • Enterococcus faecalis
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7
Q

What is ticarcillin and what is the downside to its use?

A
  • antipseudomonal PCN
  • short (4hr) DoA and high Na+ content
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8
Q

What are the clinical uses for 1st gen Cephalosporins?

  • Not best choice, but could also work on?
A
  • Surgical PPX (not colonic)
  • Skin and soft tissue infxns
  • Gm+ infxn in PCN-allergic Pts
  • Not best choice but can work on:
    • URI
    • UTI
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9
Q

What is unique about macrolide ABX dosing?

A

bacteriostatic at lower doses, bactericidal at higher doses

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10
Q
  1. What are the 3 penicillinase-resistant parenteral PCNs?
A
  • methacillin
    • d/c d/t nephrotoxic
  • oxacillin
  • nafcilin
    • most active
    • best CNS penetration
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11
Q
  1. What class is daptomycin?
  2. What are the clinical uses for daptomycin?
  3. When should daptomycin absolutely NOT be used?
A
  1. Cyclic lipopeptide
  2. Staph aureus bacteremia and complicated skin/structure infxn
  3. Ø be used for treatment of pneumonia
    • ↑ death rate and serious cardiopulm adverse events vs comparator
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12
Q

What do 3rd gen Cephalosporins have:

  • moderate activity for?
  • less activity for vs. 1st or 2nd gen
A
  • moderate vs. pseudomonas
  • Gm+ cocci
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13
Q

What are fluoroquinolones used for?

A
  • Excellent for:
    • Gm- aerobes (H. flu, P. aeruginosa, Enterobacter)
    • Shigella and Salmonella
  • Atypical organisms
  • Mycobacterium
  • Less used for:
    • staph (good, resistance ↑), moderate strep
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14
Q
  1. For what conditions do the risks of using fluoroquinolones outweigh the benefits?
  2. What is the serious side effect included in this FDA warning?
A
  1. conditions:
    • acute sinusitis
    • acute bronchitis
    • uncomplicated UTI
  2. serious tendonopathies
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15
Q

What are the oral formulations of aminopenicillins?

  • issues/benefits?
  • dosing?
A
  • ampicillin
    • diarrhea, rash
    • QID admin
  • amoxicillin
    • better absorption, less GI effects
    • TID
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16
Q

What are aminopenicilins and what makes them unique?

A
  • Extended spectrum PCNs
  • good as PCN G for Strep and pneumococci
  • Also includes some gram (-)
    • “NSHEPS”
      • N. meningitidis
      • Salmonella
      • H. influenzae
      • E. coli
      • P. mirabilis
      • Shigela
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17
Q

What are the general guidelines for ABX?

A
  • Approved ABX
  • Narrowest spectrum
  • Proper dose
  • Shortest duration
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18
Q

What is empiric therapy?

A
  • ABX therapy used to treat a known/suspected infxn where organism is not specifically known
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19
Q

How is clindamycin used today?

A
  • Acne vulgaris
  • toxoplasmosis and plasmodium (protozoa)
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20
Q

What is the microbiologic activity for macrolide ABX?

A
  • Gm +
  • Gm - (H. flu)
  • genital pathogens
    • N. gonorrhoeae, Chlamydia trachomatis, Treponema pallidum
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21
Q

What is the 4th gen Cephalosporin?

A

Cefepime (cefazolin [1st] + ceftazidime [3rd])

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22
Q

What are some “atypical” URI pathogens and what makes each unique?

A
  • Mycoplasma pneumoniae
    • no cell wall
  • Chlamydophila pneumoniae
    • must infect another cell to reproduce
  • Legionella pneumophilia
    • unique lipopolysaccharide content in outer cell membrane
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23
Q

What are the 4 major mechanisms of ABX resistance?

A
  1. destroy the drug
    • enzymatic b/d
  2. limiting access into cell
    • thickened cell wall
  3. change drug target
    • altered binding site
  4. pump drug out of cell
    • efflux pump
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24
Q

What is minimum bactericidial concentration (MBC)?

A
  • [Lowest] of ABX that kills 99.9% of the initial inoculum
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25
Q

What are the common gram negative pathogens?

A
  • Enterobacteriaceae
    • PEcK (Klebsiella, E. coli, Proteus)
    • Shigella, Salmonella
  • SPACE bugs
    • Serratia
    • Pseudomonas
    • Acinetobacter
    • Citrobacter
    • Enterobacter
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26
Q

What is a minimum inhibitory concentration (MIC)?

A
  • [Lowest] of an ABX that inhibits VISIBLE growth of an organism
    • quantitative measure of Rx activity vs a bacteria
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27
Q

What are the 3rd gen Cephalosporins?

A
  • Oral
    • cefditoren
    • cefdibuten
    • cefdinir
  • Parenteral
    • cefotaxime
    • ceftazidime
    • ceftriaxone
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28
Q
  • What is the spectrum of activity for the 5th gen Cephalosporin?
  • What’s it good for?
A
  • Spectrum:
    • Gm+ and MRSA
    • less Gm- vs 4th gen
  • Good for:
    • MSSA and MRSA
    • Streptococcus
    • GNRs
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29
Q

What is fidaxomicin?

Difi cid(e)

A
  • a non-absorbable macrolide-like antibiotic
    • so concentrates in the gut
  • used exclusively for infxn of C. diff
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30
Q
  1. What is PCN VK
  2. Dosing?
  3. Main Uses?
A
  1. An acid stable form of oral natural PCN
  2. 125-250 mg q6hr
  3. Strep pharyngitis, PPX for rheumatic heart dz
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31
Q

How are 3rd gen Cephalosporins generally used?

A
  • Gm- meningitis
  • CAP and HAP
  • bacteremia
  • febrile neutropenia
  • complicated UTI
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32
Q
  1. What is Procaine PCN G?
  2. Uses?
  3. Dosing?
A
  1. IM only PCN G that has detectable levels for 12-24 hours
  2. used to treat gonorrhea
  3. doses q8-12 hr
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33
Q

What organisms are 3rd gen Cephalosporins generally used for?

A
  • generally used for more Gm- organisms
    • enhanced activity against “SHEEP”
      • Serratia
      • H. influenza
      • Enterobacter
      • E. coli
      • Proteus
34
Q

What are the 4 carbapenems?

A
  • doripenem
  • imipenem
    • combined 1:1 w/ cilastatin
  • meropenem
  • ertapenem
35
Q

What are the different CLSI Interpretive Criteria?

A
  • susceptible
    • infxn d/t isolate may be treated w/ nml dose of recommended agent
  • intermediate
    • infxn may be treated at body sites where:
      • Rx physiologically concentrated, or
      • higher doses can be used
  • resistant
    • infxn Ø inhibited by usually achievable concentrations w/ nml dosing schedule
36
Q

What is the microbiologic activity of tetracyclines?

37
Q

What is the spectrum of activity for 2nd gen Cephalosporins?

A
  • 1st gen activity, plus…
    • H. influenzae
    • M. catarrhalis
    • N. meningitidis
    • N. gonorrhoeae
38
Q

What are two of the major limiting factors for tetracyclines?

A
  • That they are bacteriostatic
  • They are good at everything but not great against anything
39
Q

What are the indications for SMX-TMP?

A
  • UTI
  • URI - in areas where resistance low
  • Salmonella, Shigella
  • Travelers diarrhea
  • PCP infxns - terminal HIV
    • Pneumocystis jiroveci
40
Q

What is the spectrum of activity for natural PCNs?

A
  • non-β lactamase producing gram + cocci
    • streptococci
    • Enterococcus faecalis
  • gram + anaerobes, except C. diff
  • spirochetes
    • Treponema pallidum
41
Q

What are the 1st gen Cephalosporins?

A
  • Oral
    • cephalexin Keflex
    • cephradine Duracef
    • cefadroxil Velocef
  • Parenteral
    • cefazolin Ancef
42
Q
  1. What are penicillinase-resistance PCNs used for?
    • Also works on?
    • Doesn’t work on?
A
  1. Choice Rx for penicillinase-producing Staph aureus
    • Strep (no better than PCN G)
    • Ø against enterococci or gram (-) infxns
43
Q

What 4 major groups of ABX are β-Lactams?

A
  1. PCNs
  2. Cephalosporins
  3. Carbapenems
  4. Monobactams
44
Q

What are some of the ABX selection criteria used?

A
  • Effectiveness against pathogen
  • Site of Infxn
  • Host Defenses
    • cidal vs static
  • Allergy
  • Pt Variables
    • Age, pregnancy, genetics
45
Q

What are glycopeptides used for?

A
  • Gm + aerobes
    • Staph, including MRSA
    • Enterococcus
    • Strep, including PCN resistant
  • Gm + anaerobes
    • Clostridium, including C. diff
  • Gram + ONLY
46
Q

What are the 4 major MoA for ABX?

A
  • Cell wall synthesis inhibitors
    • PCN and Cephalosporins
  • RNA or DNA synthesis inhibitors
    • Rifampin and Fluoroquinolones
  • Protein synthesis inhibitors
    • TCN and Macrolides
  • Antimetabolites
    • Sulfonamides
47
Q

What are the macrolide ABX?

A
  • erythromycin
  • clarithromycin
  • azithromycin
48
Q

What are the two oral penicillinase-resistant PCNs?

A
  • dicloxacillin
    • good oral absorb
    • 125-250 mg q 6 hours
  • cloxacillin
    • best oral absorb
    • 250-500 mg q 6 hours
49
Q

What is one important point that MIC’s do not take into account?

A

the site of infxn

50
Q

What is a Clostridium difficule infxn and how is it treated?

A
  • An ABX-induced overgrowth of C. diff that → severe diarrhea and serious bowel inflammation
  • Normally treated w/ oral vancomycin (cheaper)
    • Or they put it up your butt if you can’t swallow
51
Q
  1. What are aminoglycosides used for?
  2. What are the ADRs for these drugs?
A
  1. powerful Gm- activity
  2. ADRs:
    • nephrotoxicity
    • ototoxicity
52
Q

What are the vancomycin ADRs?

A
  • nephrotoxicity
  • ototoxicity
    • tinnitis, vertigo, hearing loss
  • neutropenia
  • phlebitis
  • more common in the past:
    • red man syndrome
      • purified formulation has ↑ safety profile
53
Q

What S/Sx differentiate Type I rxns from other Type rxns?

A
  • bronchconstriction
  • laryngeal edema
  • urticaria (hives)
  • hypotension
  • anaphylaxsis
54
Q

What are the detection methods used?

A
  • Serology (antibodies)
  • Direct Detection
    • special stains
    • antigen
    • toxin
    • molecular assays
  • Culture
    • biochem rxn
    • antimicrobial susceptibility
55
Q

How is the 4th gen Cephalosporin primarily used?

A
  • Empiric therapy drug
    • try and kill everything drug
56
Q

What are the names of the short-acting and long-acting tetracyclines?

A
  • SA = tetracycline
  • LA = doxycycline and minocycline
57
Q

What is sulbactam and how is it used?

A
  • a β-lactamase inhibitor combined with the amino PCN ampicillin
  • makes a parenteral formulation called Unasyn
58
Q
  1. What is piperacillin?
  2. What is it mixed with to prevent β-lactamase b/d?
A
  1. A low Na+ content potent antipseudomonal PCN
  2. tazobactam
59
Q

What are 1st gen Cephalosporins ineffective against?

A
  • ineffective against other:
    • Enterobacter
    • H. influenza
    • Proteus and Pseudomonas
    • Serratia and Salmonella
60
Q

What is SMX-TMP and what is its microbiologic activity?

A
  • bacteriocidal combo of sulfamethoxazole-trimethoprim
  • activity against:
    • Gm + and Gm - aerobic activity
    • Chlamydia
    • Protozoa
61
Q

What are the 3 big categories of gram positive pathogens?

A
  • Staphylococcus
  • Streptococcus
  • Enterococcus
62
Q
  1. What is aztreonam?
  2. What is its spectrum of activity?
  3. For what condition is it given as an alternative?
A
  1. a monobactam that’s cetazidime’s cousin
  2. Gm- ONLY
  3. Given if type-I PCN allergy present d/t no cross-reactivity with other β-lactams
    • way to replace 3rd gen Cephalosporins when allergy present
63
Q

What is the 5th gen Cephalosporin?

A

Ceftaroline

64
Q

What are the main aminoglycoside agents?

A
  • gentamicin
  • tobramycin
  • neomycin
65
Q

What is the cyclic lipopeptide drug?

A

daptomycin

66
Q
  1. Approach if PCN allergy w/ drug fever or maculopapular rash occurs?
  2. Approach if PCN allergy w/ hives or anaphylaxis occurs?
A
  1. Cross sensitivity w/ β-lactam (3-5%) low so may safely give other β-lactams
  2. Do NOT give β-lactams w/ potential cross-reactivity (Type I)
    • give aztreoman instead (β-lactam ABX that can be used)
67
Q

What are the components of ABX Stewardship?

A
  • Appropriate Dx
    • indication for ABX?
  • Appropriate antimicrobial therapy
    • ABX choice
    • Dose: adjustment for renal fxn or Wt
    • Duration
68
Q

What are 1st gen Cephalosporins active against?

A
  • Gm+ cocci (Staph and Strep)
    • except MRSA
  • Most Gm+ anaerobes
    • except B. fragilis
  • Okay-ish GNR like Klebsiella and E. coli
69
Q

When does desensitization therapy work?

A

Only for Type I Hypersensitivity reactions

70
Q

What are the only 4 PCNs Ø destroyed by β-lactamases?

A
  • oxacillin
  • nafcillin
  • dicloxacillin
  • cloxacillin
71
Q

What is definitive/directed therapy?

A
  • ABX therapy used after C/S is known
72
Q
  1. What is Augmentin and what SE issues does it have?
  2. What can you now kill with Augmentin?
A
  1. oral amoxicillin combined w/ clavulanic acid (β-lactamase inhib)
    • more GI SE
  2. Gram (+) streptococci, “NSHEPS”, and any of these that NOW produce β-lactamases
73
Q
  1. What is Benzathine PCN G
  2. Uses?
  3. Dosing?
A
  1. IM only PCN G that has detectable levels for 15-30 days
  2. treats syphilis, pharyngitis
  3. q weekly
74
Q
  1. What is another formulation of natural PCN?
  2. What can it penetrate?
  3. How is it eliminated?
  4. What is the T1/2 and what does this mean for dosing?
  5. What are its clinical uses?
A
  1. Aqueous PCN G (parenteral)
  2. BBB
  3. 90% renally
  4. VERY Short T1/2 (30 mins) + Time-dpdt killing = q4-6 hr admin
  5. neurosyphilis, endocarditis
75
Q

What are the carbapenems used for?

A
  • Wide range of bacterial infxns
    • LRI
    • CNS infxn
    • skin/soft tissue
    • bone and joint
    • intra-ABD
  • Empiric therapy for severe systemic infxn and/or mixed infxns
76
Q

What are the Gm - Neisseria pathogens?

A
  • N. meningiditis
  • N. gonorrhoeae
77
Q

What are the glycopeptides?

A
  • vancomycin
  • telavancin
78
Q
  1. How do all β-Lactams work?
  2. How are most eliminated?
  3. When do they not typically work?
A
  1. All have bacteriocidal action by inhibiting cell wall synthesis in time-dependent manner
  2. Most are renally eliminated
  3. Ø coverage for atypicals
79
Q

What are the 2nd gen Cephalosporins?

A
  • Oral
    • cefaclor
    • cefprozil
    • cefuroxime axetil
    • loracarbef
  • Parenteral
    • cefuroxime
    • cefoxitin
    • cefotetan
80
Q

What is metronidazole primarily used for?

A
  • bacteriocidal action against:
    • Gm + and Gm - anaerobes
    • Trichomonas vaginalis
    • Giardia lamblia
    • C. diff

Karboski's Pharmacology - UT AEMSN (11 decks)

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