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FNP Pharmacology > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Penicillins

A

Beta Lactams
MOA- Inhibit the biosynthesis of petidoglycan bacterial cell wall
Sensitivity- Effective against streptococcus (Group A and B), enterococcus, staphylococci

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2
Q

Aminopenicillin Sensitivity

A

(e. g. Ampicillin, Amoxicllin)
- beta Lactam
- Effective against strep, some enterococcus, and some staphylococci
- Combining with beta lactase inhibitor (clavulanic acid, sulbactam, tazobactam) is synergistic and broadens the spectrum against more microorganisms including: MRSA, streptococcus, E Coli, clostridium, Klebsiella Proteus, shigella, salmonella

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3
Q

Tetracycline and Minocycline

A

Class: Tetracyline
MOA: inhibit protein synthesis
Clinical use: P. acnes, some H. pylori regimens
AE: renal, hepatoxcicity, GI runs, photosensitivity, Steve-Johnsons Syndrome
Contraindications: Pregnancy class X, DO NOT use in pregnant women, lactating women, children <8 yrs.

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4
Q

Vancomycin

A

Class: Glycopeptides
MOA: inhibits cell wall synthesis
Clinical use: Used to treat serious gram-positive infections that are resistant to other antibiotics
e.g. Vancomycin IV treatment of MRSA
Oral vancomycin is used to treat C. difficile colitis
AE: Ototoxicity (transient or permanent)
Nephrotoxicity
“Red Man” syndrome if infused too fast
Contraindications:
Misc: oral absorption poor from GI, IV excreted by kidneys and PO excreted in the feces

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5
Q

Acyclovir

A

Class: Antiviral-Nucleoside Analogues
MOA: inhibit viral replication
Clinical use: active against HSV 1 and 2, varicella-zoster virus (VZV), Epstein-Barr virus (EBV), Cytomegalovirus (CMV), and herpes virus 6
AE: Headache, nausea, vomiting, skin rash, diarrhea, renal impairment

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6
Q

Anti-pseudomonal PCN Sensitivity

A

(Piperacillin, ticarcillin)
Enhanced activity against gram-negative bacilli like pseudomonas aeruginosa, enterobacter, morganella, and Providencia species
-Exist as combinations with beta-lactamase inhibitors, wider spectrum of activity

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7
Q

Penicillin Pharmacokinetics

A
  • Oral PCN absorbed well orally
  • excreted as unchanged meds in urine
  • Renal failure have longer half life and increased risk of toxicity
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8
Q

PCN Adverse Reactions

A
  • Serious immediate allergic reactions in 10% of patients
  • Type I hypersensitivity reactions (anaphylaxis) occurs within 30 minutes
  • Pruritic, maculopapular rash may occur 7-10 days after starting treatment with PCN, especially aminopencillin
  • Rash is NOT a contraindication
  • GI symptoms: diarrhea, nausea, vomiting
  • bacterial or fungal overgrowth, C diff may occur
  • Pregnancy category B
  • Small concentrations in breast milk
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9
Q

PCN clinical use

A
  • Safe for children and adults
  • Otitis Media (amoxicillin)
  • Sinusitis (Amoxicillin in peds, amoxicillin/clauvulnate in adults)
  • Pharyngitis (GBA strep 1st line PCN)
  • wound infections (amoxiclilin/clauvulnate 1st line for prophylaxis after animal bite and post op wounds)
  • STI (Syphlis)
  • UTI (2nd line therapy)
  • pneumonia ( 2nd line)
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10
Q

Zanamivir

A

Antiviral for influenza
MOA: Inhibits neuraminidase viral enzyme, which prevents release of the virus and further propagation
Clinical use: influenza A and B, inhaled
AE: should not be given to patients with underlying respiratory disease, adverse reactions include bronchitis, cough and dyspnea

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11
Q

Doxycycline

A

Class: Tetracyline
Pregnancy class D
MOA: inhibit protein synthesis
Clinical use: first line therapy for C. trachomatis and Ureaplasma urealyticum, some H. Pylori regimens
AE: renal, hepatoxcicity, GI runs, photosensitivity, Steve-Johnsons Syndrome
Contraindications: DO NOT use in pregnant women, lactating women, children <8 yrs.

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12
Q

Valacyclovir

A

Class: Antiviral-Nucleoside Analogues
MOA: inhibit viral replication
Clinical use: converted to acyclovir after oral administration and is active against the same viruses
AE: Headache, nausea, vomiting, skin rash, diarrhea, renal impairment
***May cause thrombotic thrombocytopenia purpura (TTP) and hemolytic uremic syndrome (HUS) in immunocompromised patients

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13
Q

Famiciclovir

A

Class: Antiviral-Nucleoside Analogues
MOA: inhibit viral replication
Clinical use: active against HSV-1 and HSV-2, VZV, EBV, and hepatitis B virus
AE: Headache, dizziness, somnolence

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14
Q

Ganciclovir

A

Class: Antiviral-Nucleoside Analogues
MOA: inhibit viral replication
Clinical use: active against CMV
AE: Granulocytopenia, anemia, and thrombocytopenia

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15
Q

Oseltamivir (Tamiflu)

A

Antiviral for influenza
MOA: Inhibits neuraminidase viral enzyme, which prevents release of the virus and further propagation
Clinical use: influenza A and B, oral route
AE: N/V, skin rxns, neuropsychiatric events
Most effective when given within 48 hours of symptom onset of the flu

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16
Q

Zanamivir (Relenza)

A

Antiviral for influenza
MOA: Inhibits neuraminidase viral enzyme, which prevents release of the virus and further propagation
Clinical use: influenza A and B, inhaled
AE: skin rxns, neuropsychiatric events
Most effective when given within 48 hours of symptom onset of the flu

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17
Q

Cephalosporin adverse reactions

A
  • Cross sensitivity with PCN, do not prescribe with history of PCN anaphylactic reaction
  • Skin rash, arthralgia, fever, renal failure, hepatic failure, anemia, diarrhea,, superinfection, C diff
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18
Q

Fluconazole

A

Class: Azole antifungal
MOA: inhibitor of CYP450 3A4 and 2C9
*requires a loading dose, has the fewest drug interactions of all the Azoles.
AE: All of the Azoles and terbinafine have been associated with hepatotoxicity. Monitor liver fxn.

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19
Q

Fluoroquinolones

A

MOA- interferes with bacterial enzymes required for the synthesis of bacterial DNA

Well absorbed, but take on empty stomach

increasingly resistant, considered broad spectrum

Do not use for gonorrhea, uncomplicated cystitis, or TB

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20
Q

Ketoconozole

A

Class: Azole antifungal
MOA: inhibitor of CYP450 3A4
AE: All of the Azoles and terbinafine have been associated with hepatotoxicity. Multiple drug interactions due to CYP3A4 enzyme inhibition. Monitor liver fxn.

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21
Q

Metronidazole

A

Clinical use: protozoal infections by T. vaginalis, G. lamblia, and E. histolytica AND anaerobic bacterial infections, bacterial vaginosis and is one of the drugs in H. pylori treatment
AE: Leukopenia, alcohol use can cause disulfiram-like rxn
Contraindications: AVOID in 1st trimester of pregnancy, can cause cleft palate

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22
Q

Azithromycin

A

Class: Macrolides
MOA: inhibit RNA dependent protein synthesis
Clinical use: Drug of choice for CAP, chlamydia, Mycobacterium avium complex (MAC), alt. for its with penicillin allergies (gram +, gram -, atypical and intracellular organisms)
Contraindications: FDA warning of cardiac arrhythmias, risk of prolonged QT interval and tornadoes de pointes
Pregnancy category B, also safe in children
*least drug interactions of the macrocodes

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23
Q

Clarithromycin

A

Class: Macrolides
MOA: inhibit RNA dependent protein synthesis
Clinical use: Drug of choice for CAP, chlamydia, Mycobacterium avium complex (MAC), alt. for its with penicillin allergies (gram +, gram -, atypical and intracellular organisms)
Pregnancy category C
Cautions: They inhibit CYP450 enzymes, particularly CYP3A4, Increased drug levels due to interaction
e.g. most statins, warfarin, digoxin, colchicine, etc.

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24
Q

Erythromycin

A

Class: Macrolides
MOA: inhibit RNA dependent protein synthesis
Clinical use: Drug of choice for CAP, chlamydia, Mycobacterium avium complex (MAC), alt. for its with penicillin allergies (gram +, gram -, atypical and intracellular organisms)
Pregnancy category B, also safe in children
Cautions: They inhibit CYP450 enzymes, particularly CYP3A4, Increased drug levels due to interaction
e.g. most statins, warfarin, digoxin, colchicine, etc.

25
Q

3rd gen Cephalosporin

A
  • Used for broader indications
  • More active against G- bacteria
  • (ceftriaxone, cefotaxime ceftazidime)
  • Ceftazidime- pseudomonas aeruginosa
26
Q

Azithromycin

A

Class: Macrolides
Contraindications: FDA warning of cardiac arrhythmias, risk of prolonged QT interval and tornadoes de pointes
Pregnancy category B, also safe in children
*least drug interactions of the macrocodes

27
Q

Clarithromycin

A

Class: Macrolides
Pregnancy category C
Cautions: They inhibit CYP450 enzymes, particularly CYP3A4, Increased drug levels due to interaction
e.g. most statins, warfarin, digoxin, colchicine, etc.

28
Q

Erythromycin

A

Class: Macrolides
Pregnancy category B, also safe in children
Cautions: They inhibit CYP450 enzymes, particularly CYP3A4, Increased drug levels due to interaction
e.g. most statins, warfarin, digoxin, colchicine, etc.

29
Q

What are some adverse rxns of the Macroclides (azithromycin, clairthromycin, erythromycin)?

A 
Most common are GI: nausea, vomiting, abdominal pain, cramping, and diarrhea
appears to be dose related
Liver abnormalities (e.g. hepatitis, hepatic failure)
Skin:  urticaria, bullous eruptions, eczema, and Stevens-Johnson syndrome
Hearing loss at high doses (which is reversible)
30
Q

Trimethoprim/Sulfamethoxazole

A

Clinical uses: Most commonly used to treat UTI infections
Trimethoprim/sulfamethoxazole may be used to treat MRSA if susceptible in some areas
Pneumocystis jiroveci pneumonia prophylaxis and treatment

31
Q

Bactrim

A

Clinical uses: Most commonly used to treat UTI infections, Pneumocystis jiroveci pneumonia prophylaxis and treatment

32
Q

Septra

A

Trimethoprim/sulfonamide

33
Q

Nitrofurantoin

A

*Pregnancy Class B
MOA: Inactivates or alters bacterial ribosomes causing inhibition of DNA synthesis, RNA synthesis, protein synthesis, cell wall synthesis, and aerobic energy metabolism.Inhibits many gram-positive cocci and gram-negative bacilli that cause UTIs.

34
Q

List 6 of the clinical uses for Macroclides

A
  1. Drug of choice for community acquired pneumonia (CAP)
  2. Treatment for Exacerbation of Chronic Bronchitis
    Patients who have COPD exacerbation with 2 of the 3 following criteria: increased sputum production, increased dyspnea, change in color of sputum
  3. Chlamydia infection
  4. H. Pylori infections (clarithromycin)
  5. Mycobacterium avium complex (MAC)
  6. Alternative for patients with penicillin allergies
35
Q

Cephalosporin Clinical Uses

A
  • 1st gen- strep pharyngitis, skin infections
  • Cephalexin, cefpodoxime, cefixime can be used as second line for UTI
  • may be used to treat AOM when amoxicillin has failed
  • Ceftriaxone and cefixime for GC/Chlamydia
  • cefpodxime, cefuroxime, or parenteral ceftriaxone followed by oral cefpodxime can be used to treat community acquired pneumonia
36
Q

Fluoroquinolones

A

MOA- interferes with bacterial enzymes required for the synthesis of bacterial DNA

Well absorbed, but take on empty stomach

37
Q

Sulfonamides

A

MOA: Inhibits dihydrofolate synthetase which blocks the synthesis of folic acid.
Uses: Sulfonamides and trimethoprim work synergistically together. Active against gram-positive bacteria, gram-negative bacteria, and some protozoa.
AE: can cause acute hemolytic anemia in patients with G6PD deficiency

38
Q

Trimethoprim

A

MOA: Inhibits dihyrofolic acid reductase which inhibits DNA synthesis.
Uses: Sulfonamides and trimethoprim work synergistically together. Active against gram-positive and gram-negative bacteria.
AE: blocks folic acid synthesis, so use caution in patient with folate deficiency and give folate supplement

39
Q

Nitrofurantoin

A

MOA: Inactivates or alters bacterial ribosomes causing inhibition of DNA synthesis, RNA synthesis, protein synthesis, cell wall synthesis, and aerobic energy metabolism.
Inhibits many gram-positive cocci and gram-negative bacilli that cause UTIs.

40
Q

List Drug interactions for Sulfonamides, trimethoprim, nitrofurantoin

A

GI: nausea, vomiting, anorexia, diarrhea, stomatitis, abdominal pain, C. difficile colitis
Skin: rashes, increased hypersensitivity reactions, photosensitivity
CNS: headache, dizziness, drowsiness
Liver: hepatitis, cholestatic jaundice
Sulfonamides can cause acute hemolytic anemia in patients with G6PD deficiency
Sulfonamides, trimethoprim, and nitrofurantoin can cause renal impairment—use with caution in patients with renal failure
Trimethoprim blocks folic acid synthesis, so use caution in patient with folate deficiency and give folate supplement

41
Q

Linezolid

A

Class: Oxalodinone
MOA: Inhibitor of bacterial ribosomal protein synthesis
Most effective against aerobic gram-positive bacteria
Uses: Pneumonia, Complicated skin infections, Treatment of MRSA infections, Treatment of Vancomycin Resistant Enterococcus (VRE) infections, Very expensive (Use other drugs first)
AE: Diarrhea, Nausea, Headache, Myelosuppression, anemia, leukopenia, thrombocytopenia resolves when discontinue drug

42
Q

Tetracyclines have activity against…

A
  1. Gram-positive bacteria
  2. Gram-negative bacteria
  3. Rickettsia (e.g. organisms that cause Rocky Mountain spotted fever, typhus)
  4. Spirochetes (e.g. Treponema pallidum that causes syphilis)
  5. Intracellular organisms (e.g. Chlamydia, Mycoplasma pneumoniae, Legionella)
43
Q

Fluoroquinolones activity

A
  • extensive activity against G- bacteria
  • E coli, proteus, serrate, klebsiella, enterobacter, haemophilus, campylobacter, salmonella, shigella, neisseria gonorrhoeae
  • some activity against G+
  • activity against atypical organisms (chlamydia, legionella, mycoplasma species)
  • Levofolaxcin and ciprofloxacin- pseudomonas aeruginosa
  • Moxifloxacin- anaerobic
  • Levofloxacin, mixofloxacin, and gemifloxacin more active against G+
44
Q

Fluoroquinolones Adverse reactions

A
  • Black box warning for tendonitis or tendon rupture
  • GI: n/v, abdominal pain, C diff, altered taste
  • Hepatic failure, renal calculi, prolonged Qt, angina, a flutter
  • Pregnancy C, avoid
  • Do not prescribe<18 years
45
Q

Fluoroquinolones Clinical uses

A
  • Complicated UTI, pyelonephritis, chronic bacterial prostatitis, pneumonia, chronic bronchitis, PCN resistant strep pneumonia, skin infections, bone/joint infections, complicated intra abdominal, infectious diarrhea
46
Q

Fluoroquinolones Monitoring

A
  • Patients with renal failure should have dosage adjusted
  • Monitor EKG for QT prolongation
  • Tendonitis or tendon rupture
47
Q

Fluoroquinolone Education

A
  • Food delays absorption
  • Many drug interactions
  • Full glass of water
  • Stop med and notify provider for tendon tenderness
48
Q

Clindamycin

A
  • inhibit protein synthesis of the bacteria, binds to 50S subunit of bacterial ribosome to suppress the protein synthesis
  • Oral is completely absorbed, not affected by food or gastric acid
  • Metabolized by the liver and excreted in bile and urine
49
Q

Clindamycin sensitivity

A
  • G+ and anaerobic organisms
  • Used to treat staph infections or strep for PCN allergic
  • decreases toxin production from strep, staph, and Clostridium
50
Q

Clindamycin adverse reactions

A
  • GI: n/v, c diff, bitter or metallic taste

Skin: rash, erythema

51
Q

Clindamycin indications

A
  • 1st line for dental infections
  • MRSA with low resistance
  • 2nd line G+ cocci
  • 2nd/3rd line treatment for upper and lower respiratory tract infections
  • Treat infections in PCN allergic
  • Pregnancy Category D
52
Q

Clindamycin

A
  • Lincosamides
  • oral is completely absorbed
  • G+ and anaerobic organisms
  • Use for PCN allergic, dental infections, low resistance MRSA, pregnancy B
53
Q

Levofloxacin

A 
Fluoroquinolone
effective against Pseudomonas aeruginosa
Broad spectrum
AVOID pregnancy and <18
Tendonitis/tendon rupture
SJ syndrome
Prolonged QT interval common
54
Q

Ciprofloxacin

A 
Fluoroquinolone
effective against Pseudomonas aeruginosa
Broad spectrum
AVOID pregnancy and <18
Tendonitis/tendon rupture
SJ syndrome
Prolonged QT interval common
55
Q

Moxifloxacin

A 
Fluoroquinolone
Anaerobic organisms
Avoid pregnancy and <18
SJ syndrome
Prolonged QT
56
Q

Cephalexin

A

First gen Cephalosporin

G+ bacteria, MSSA, staph epidermidis, most strep

57
Q

Cefazolin

A

First gen Cephalosporin

G+ bacteria, MSSA, staph epidermidis, most strep

58
Q

Cefotetan

A

2nd gen cephalosporin

G+ bacteria, MSSA, staph epidermidis, most strep, Klebsiella, proteus, e coli

59
Q

cefoxitin

A

2nd gen cephalosporin

G+ bacteria, MSSA, staph epidermidis, most strep, Klebsiella, proteus, e coli

FNP Pharmacology (1 decks)

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