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Clinical Management exam I > antibiotics > Flashcards

antibiotics Flashcards

1
Q

Name the naturally occurring PCNs and their ROI.

A 
Penicillin VK (PO)
Penicillin G (IV or IM)
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2
Q

Name the Anti-staphylococcal PNCNs.

A

Dicloxacillin (PO)
Nafcillin (IV)
Oxacillin (IV)

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3
Q

Name the Aminopenicillins

A

Amoxicillin (PO)

Ampicillin (IV)

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4
Q

Name the Antipseudomonal penicillins

A

Piperacilline (IV)

Ticarcillin

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5
Q

Name the two Beta-lactamase/PNCN combo

A

Zosyn (antipseudomonal)

Unasyn (anti-Acinetobacter)

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6
Q

what are first line abx in tx MSSA?

A

Dicloxacillin (PO)
Nafcillin (IV)
Oxacillin (IV)

(Anti-staphylococcal PNCNs)

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7
Q

what would we use to tx Syphilis ?

A

Pen G

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8
Q

*only PCN doesn’t require renal dosing??

A

Dicloxacillin
Nafcillin
Oxacillin

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9
Q

describe the coverage of Anti-Staphylococcal

PCNs (diclox, naf, oxa)

A

GREAT MSSA COVERAGE

Broader gram + coverage

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10
Q

gold standard for tx of listeria

A

ampicillin

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11
Q

what would you prescribe Amoxicillin for?

A

Otitis media

UTIs/URIs
Meningitis (ampicillin)

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12
Q

describe coverage for ampicillin/amox

A

PCN + added Gram negative coverage (E. coli, H. flu, salmonella)

Enterococcus
Listeria and Shigella (Ampicillin preferred)

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13
Q

β-lactam + β-lactamase Inhibitors include zosyn and unasyn among others, which of the 2 is equivalent to augmentin PO?

A

unasyn

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14
Q

β-lactam + β-lactamase Inhibitors include zosyn and unasyn among others, which of the 2 is used to tx P. aeruginosa?

A

zosyn

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15
Q

β-lactam + β-lactamase Inhibitors include zosyn and unasyn among others, which of the 2 is used to tx Acinetobacter?

A

unasyn

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16
Q

what would you use to tx Human bites + Animal Bites

A

augmentin

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17
Q

Name the 1st gen cephs?

A

Cefazolin (Ancef) (IV)
Cephalexin (Kelfex) (PO)
Cefadroxil (Duracef) (PO

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18
Q

Name the 2nd gen cephs (2A)

A

Cefuroxime (Ceftin)
Cefaclor
Cefprozil

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19
Q

Name the 2nd gen cephs (2B)

A

Cefoxitin

Cefotetan

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20
Q

Name the 3rd gen cephs

A 
Anti-pneumococcal
Cefotaxime
Ceftriaxone 
Cefixime
Cefpodoxime

Antipseudomonal
Ceftaz

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21
Q

name 4th gen cephs

A

Cefepime IV

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22
Q

name 5th gen cephs

A

Ceftaroline IV

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23
Q

name the abcx prescribes SECOND line for MSSA infection?

A

1st gen cephs
Cefazolin (Ancef) (IV)
Cephalexin (Kelfex) (PO)
Cefadroxil (Duracef) (PO

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24
Q

what would we use 1st gen cphs to tx?

A 
Skin infections
SECOND line for MSSA 
SSTI
UTI
Pre-op abx
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25
Q

Out of the cephalosporins what would tx?
Respiratory tract infections
Sinusitis, otitis, etc

A

2nd gen (2A)

Cefuroxime (Ceftin)
Cefaclor
Cefprozil

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26
Q

Out of the cephs what covers:
Skin infections
MRSA / VRSA
VSE

A

CeftarolineIV (5th gen)

gram +/- aerobes

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27
Q

out of the cephalosprins which cover pseudomonas?

A

3rd gen antipseudo -> ceftaz

4th gen -> Cefepime (IV)

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28
Q

name the Anti-pneumococcal cephs

A

Cefotaxime
Ceftriaxone
Cefixime
Cefpodoxime

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29
Q

what would we prescribe for tx of Gonorrhea ?

A

Gonorrhea (ceftriax)

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30
Q

what would we prescirbe if their was an infection due to b. fragillis

A

2B
Cefoxitin
Cefotetan

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31
Q

what ceph covers: gram -
Abdominal infections
GYN infections

A

includes b.fragilis !!

Cefoxitin
Cefotetan

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32
Q

what could we use ceftaz to tx

A

HA pneumonia

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33
Q

what would we use to tx Neutropenic fever

A

Cefepime (Maxipime)

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34
Q

name the carbapenems

A

Primaxin (imipenem/cilastatin)
Meropenem
Doripenem
Ertapenem

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35
Q

Drug of choice for ceftriaxone-resistant E. coli

A

carbapenems:

Primaxin (imipenem/cilastatin)
Meropenem
Doripenem
Ertapenem

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36
Q

Name ADRs of carbapenems

A

Highest risk of seizures
Carbapenem resistant Enterobacteriaceae (CRE)
Expensive

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37
Q

coverage of carbapenems

A

gram +/- aerobes

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38
Q

name things carbapenems tx:

A 
Ceftriaxone resistant E. coli 
Klebsiella 
ESBL
Complicated UTI 
Intraabdominal infection
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39
Q

name coverage of vanco

A

Gram (+) aerobes & anaerobes

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40
Q

what are indications for using vanco IV

A 
Hospital acquired pneumonia 
Skin infections (MRSA)
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41
Q

why would you usevanco PO?

A

tx C. diff - PO

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42
Q

name ADRs of vano

A

Red-man syndrome
Ototoxicity/ nephrotox
C/I in corn hypersensitivity
Dosing renal & weight adjusted

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43
Q

what is VERY important in putting in your order when dosing vanco

A

TDM of trough – order 30 min before 4th dose

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44
Q

Name the tetracyclines

A

Doxycycline (IV or PO)
Tetracycline
Minocycline

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45
Q

indications for tetracyclines:

A

Respiratory tract infections
Skin infections (MRSA)
Tick-bourne infections

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46
Q

coverage of tetracyclines

A

Strep
Staph (MSSE, MRSA)
Neisseria sp. (gram (-))
Atypicals (ex. lyme. Mycoplasma, chlamydia)

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47
Q

ADRs of tetracyclines

A 
CI in children under 8
avoid in pregnancy 
Drug intx w/ Ca, Fe, Mg Al
Metabolized in liver 
GI sensitivity
Photosensitivity
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48
Q

what class of dugs has Black box warning for causing tendinopathies (elderly and young)

A

FQs

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49
Q

what classes of drugs decrease seizure threshold and should be avoided in pts who experience seizures?

A

FQs

Carbapenems

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50
Q

FQs can tx UTIs EXCEPT:

A

Moxifloxacin (no gram-)

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51
Q

FQs can tx resp. tract infections EXCEPT

A

Ciprofloxacin (no gram +)

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52
Q

indications for prescribing FQs

A

UTI (except moxi)
Respiratory tract infections (except cipro)
Intrabdominal infections
Osteomyelitis

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53
Q 
drug class w/ ADRS including:
Hypoglycemia/hyperglycemia 
Delirium in the elderly (mental status change)
QTc prolongation
A

FQs

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54
Q

coverage of FQs

A

Gram (+) (except cipro)
Gram (-) (except moxi)
Atypical – chlamydia, legionella, mycoplasma
Enterobacteriaceae – H.flu M. cat, Niserria

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55
Q

which class of abx is known to have EXCELLENT atypical coverage?

A

FQs

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56
Q

what FQs could we use to tx M. tuberculosis

A

moxi

levo

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57
Q

whoch abx has an ADR of possible causing C. Difficile/ diarrhea

A

clinda

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58
Q

what abx could we use to tx NF

A

clinda

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59
Q

coverage of clinda

A

Strep
Staph (MSSA, MRSA)
Gram (+) anaerobes – w/ PSN allergy

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60
Q

name some indications for prescribing clinda

A 
Skin infections (CA-MRSA)
Dental infections 
Respiratory tract infections 
Nec fash
Pregnant women colonized w/ MRSA
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61
Q

name macrolide abx

A

Azithromycin (IV or PO)(Z-pak)

Erythromycin (IV or PO)

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62
Q

tx of AOM, pharyngitis in PCN allergy

A

macrolide (azith/eryth)

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63
Q

coverage of macrolides

A

Group A strep
GNR – H. flu, M/ cat, Neisseria
Atypicals – chlamydia, legionella, m. pneumonia

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64
Q

what class of abx are NEVER USED for: SEPSIS, urine or soft tissue infections

A

macrolide

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65
Q

ADRs of macrolides

A 
QTc prolongation (risk of sudden cardiac death)
Liver metabolized
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66
Q

macrolides are used to tx respiratory tract infections, pharyngitis in PCN allergy and what else? (2 things)

A

Chlamydia

Travelers diarrhea

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67
Q

what abx is indicated for coverage of
Anaerobes (b. fragilis + c. diff)
Parasites

A

Metronidazole (flagyl)

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68
Q

FIRST line for tx of c. diff

A

Metronidazole (flagyl)

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69
Q

indications to prescribes Metronidazole (flagyl)

A

Intra-abdominal infections
C. diff – FIRST line
Vaginosis

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70
Q

____________ is often added to other abx when treating intraabdominal infections

A

Metronidazole (flagyl)

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71
Q

ADRs of Metronidazole (flagyl)

A

Should not take with alcohol (disulfiram-like reaction)
GI intolerance
Metallic taste
periph. neuropathy

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72
Q

Bactrim is dosed based on the _______ component

A

trimethoprim

73
Q

name the abx used to tx opportunistic infections?

name some opportunistic infections

A

bactrim

pneumocystitis, nocardia, toxoplasmosis

74
Q

coverage of bactrim

A

Staph MSSA and MRSA

Mild strep (s. pneumoniae, s. pyogenes)

Gram negatives (ex. E. coli, K. pneumoniae,

Enterobacter (M. catarrhalis, H. flu, Salmonella, shigella)

75
Q

indications for bactrim

A

UTIs

Skin and soft tissue infections

Opportunistic infections (pneumocystitis, nocardia, toxoplasmosis)
Plasmodium
76
Q

does bactrim cover atypicals or pseudomonas?

A

NO!

Strep
Staph (MSSA, MRSA)
Gram (-) aerobes

77
Q

name some ADRs of bactrim

A 
Hyperkalemia 
Drug interaction w/ warfarin & phenytoin (INR) 
Renal dosing 
Avoid in pregnancy 
Photosensitivity 
Bone marrow suppression
78
Q

______ has a drug interaction w/ warfarin & phenytoin so we should ALWAYS order an INR!!!

79
Q

abx to avoid in pregnancy

A

bactrim
tetracyclines
FQs

80
Q

why should we avoid bactrim in pregnancy?

A

causes bone marrow suppression

81
Q

name abx where we must monitor trough levels

A

vanco

Aminoglycosides (gentamycin)

82
Q

ADRS of Aminoglycosides

A

Acute kidney injury (nephrotoxic)

Ototoxic

83
Q

name the aminoglycosides

A 
Amikacin (IV)
Gentamicin 
Tobramycin
Plazomicin 
Streptomycin
84
Q

second line tx of TB?

A

aminoglycosides - Streptomycin

85
Q 
class of abx that has: 
Excellent Gram negative coverage including P. aeruginosa along with 
Synergy against Gram positives
A

aminoglycosides

86
Q

indications for prescribing aminoglycosides

A

Hospital-acquired infections

Endocarditis

TB

87
Q

Aminoglycosides are NOT often used alone except for treating ____?

88
Q

ADRs for aminoglycosides

A

nephrotoxicity

MONITOR trough levels

89
Q

what abx are urinary antiseptics

A

Nitrofurantoin
(Macrobid; Macrodantin)

Fosfomycin (Monurol)

90
Q

_______ typically drug of choice to tx UTIs in pregnancy (except after week 38)

A

Nitrofurantoin

91
Q

Nitrofurantoin (does /does not??) penetrate ureters.

A

DOES NOT penetrate ureters

limited to lower UTI infections

92
Q

coverage of Nitrofurantoin

A

Enterococcus (VSE & VRE)
GNR
E. coli

93
Q

ADRs of Nitrofurantoin

A

CrCl <60 ml/min (RENAL DOSE)
Hepatotoxicity
Pulmonary toxicity
Neuropathy

94
Q

what abx covers:

Gram (+) aerobes & anaerobes ONLY
MRSA/ VRE

and DOES NOT need to be renally dosed?

95
Q

ADRS of what abx?

Serotonin syndrome
HTN crisis
Tyramine-containing foods
Thrombocytopenia

96
Q

indications for prescribing linezolid

A

Pneumonia
Skin infections
Bacteremia/sepsis
MRSA in SEVERLY compromised kidneys

97
Q

what do we prescribe for MRSA in SEVERLY compromised kidneys

98
Q

what abx cannot be used in pneumonia?

A

daptomycin

binds to lung surfactant

99
Q

coverage of daptomycin

A

Gram positives only (including MRSA and VRE)

100
Q

ADRs of daptomycin

A

Myalgia
Neuropathy
elevation in CPK
Rhabdomyolysis

101
Q

indications for prescribing daptomycin

A

Skin infections
Bacteremia
Endocarditis
Osteomyelitis

102
Q

besides vanco PO what abx is ONLY used for c. diff?

A

Fidaxomicin (Dificid) (PO)

103
Q

Fidaxomicin (Dificid) has a _____ fecal concentration and _____ serum concentration.

A

high fecal

low serum

104
Q

One dose of _____ lasts 72-84 hours in bladder!

A

Fosfomycin (PO)

105
Q

coverage of Fosfomycin

A

Enterococcus (VSE, VRE)
Staphylococcus (MSSA, MRSA)
GNR
Pseudomonas

106
Q

indications for Fosfomycin

A

UTI – recurrent

Cystitis

107
Q

indications for Nitrofurantoin

A

UTI – in pregnant women
Chronic UTI suppression
Cystitis

108
Q

what would we avoid FQs in children?

A

avoid in young children due to risk of inappropriate formation of cartilage

109
Q

Seizures: Risk with all beta-lactams if inappropriately adjusted for _____ function

110
Q

abx that are Hepatotoxic

A

nafcillin
oxacillin
fluoroquinolones,

111
Q

Macrolides (_________): risk of sudden cardiac death, ___ ______

A

azithro

Qtc prolongation

112
Q

beta-lactams with highest seizure risk

A

Cefepime
Fluoroquinolones
Carbapenems

113
Q

class of abx that cause QTC prolongation

A

FQs

macrolides (azithro)

114
Q

what ADR are we most worries about w/ daptomycin? (think what increases?)

A

increased CK (rhabdomyolysis)

115
Q

abx casuing photosensitivity

A

tetracyclines

bactrim

116
Q

Tx for c. diff

A

Metronidazole (flagyl) IV or PO
Vancomycin PO only

alternatives:
clinda
ampicillin
amoxicillin
FQs
cephs
117
Q

VSE UTI susceptible options

A

Nitrofurantoin
fosfomycin

Amoxicillin
amoxicillin/clavulanic acid

Doxycycline

118
Q

VSE Infections Parenteral – susceptible enterococci

A

Ampicillin (Gold standard)
Penicillin G
Vancomycin
+/- Gentamicin depending on illness severity

119
Q

abx for VRE

A

Daptomycin
Linezolid
Tigecycline
Telavancin

May use any of the VSE if susceptibility indicates

120
Q

PO options for MRSA

A

Bactrim DS
Clindamycin
Tetracyclines
Linezolid

121
Q

IV options for MRSA

A 
Vancomycin
Daptomycin
Linezolid
Tigecycline
Telavancin
Ceftaroline
122
Q

abx cover pseudomonas

A

Beta-lactams
Piperacillin/Tazo (Zosyn)
Ceftazadime
Cefepime

Fluoroquinolones (except moxifloxacin)
Aminoglycosides

123
Q

abx that cover atypicals

A

Macrolides
tetracyclines
FQs

124
Q

indication for rifampin

A

TB - absorbed in CSF
MSSA
MRSA

125
Q

coverage of rifampin

A 
Gram + (some gram -)
MSSA
MRSA
haemophilus
neisseria meningitis
126
Q

ADR rifampin

A

myalgia
arthralgia
hyperbilirubinemia

127
Q

Time-dependent killing

A

exert optimal bactericidal effect when drug concentrations are maintained above the MIC.

Higher frequency of dosing.

b-lactams

128
Q

Concentration-dependent killing

A

achieve increasing bacterial kill with increasing levels of the drug. Continue to have activity even after the antibiotic level falls below the MIC.

Higher doses and lesser frequency.

aminoglycosides
FQs

129
Q

AUC:MIC

130
Q

Time Dependent Drugs should be dosed ___ per day.

A

3-4 times per day

Beta-lactam antibiotics, such as penicillins and cephalosporins

131
Q

Concentration Dependent Drugs should be dosed ___ per day.

A

once- or twice-daily dosing is optimal, to ensure high peak concentrations.

Aminoglycosides and fluoroquinolones

132
Q

Synergistic drug combo to treat complicated MSSA

A

nafcillin + gentamicin

133
Q

____+_____ use is often reserved for prosthetic valve endocarditis or prosthetic joint infections

A

nafcillin + gentamicin

134
Q

abx with no dosing adjustments needed

A

Ceftriaxone
nafcillin
oxacillin
linezolid

135
Q

MOA of beta-lactams

A

MOA: Inhibits Penicillin Binding Proteins (PBPs )
Inhibits the cross-linking of peptidoglycan.
Prevents the development of bacterial cell wall.

136
Q

beta lactams are (concentration / time) dependent and (bactericidal / bacterialstatic) except for _____.

A

times

Bactericidal

Enterococcus

137
Q

how are most beta lactams eliminated?

A

Most are renally eliminated

Except: nafcillin, oxacillin, ceftriaxone

138
Q

Pcn – resistance (2 ways)

A

Beta lactamase enzymes inactivate the antibiotic - more common, cleave beta-lactam ring

Modification of the target PBP/low or decreased affinity for Penicillin Binding Protein- MRSA, s. pnuemoniae

139
Q

how to overcome Streptococcus pneumoniae resistance

A

high dose amoxicillin

switch to cephalosporin or other agent

140
Q

Method to overcome beta-lactamase enzymes

A

Beta Lactamase Inhibitors

141
Q

MOA of Beta Lactamase Inhibitors

A

Inhibit some, but not all beta-lactamases

Binds to beta-lactamase, i.e. suicide gene

Prevents the destruction of the parent drug

142
Q

Most common mechanism of resistance that typically occurs with gram negative organism

A

beta-lactamase enzymes overcome w beta-lactamase inhibitors

Clavulanic Acid + Amoxicillin (Augmentin)
Sulbactam + Ampicillin (Unasyn)
Tazobactam + Piperacillin ( Zosyn)

143
Q

it is important to note that Beta Lactamase Inhibitors DO NOT TREAT?

A

EXTENDED SPECTRUM BETA-LACTAMASES (ESBL) ENTEROBACTERIACIAE.

144
Q

when treating otitis media what is the antibiotic with additional beta-lactamase coverage recommended if child has already received amoxicillin in past 30 days?

A

amoxicillin-clavulanate

145
Q

cephalosporins MOA

A

Work in a way similar to PCNs by binding to and blocking the activity of enzymes responsible for making peptidoglycan.

So if there is no peptidoglycan – No cell WALL can be produced.

146
Q

Rash w/ PCN what is the thought process when prescribing?

A

may consider cephalosporin with decreasing levels of cross reactivity or carbapenem

1st->2nd->3rd generation cephalosporin decrease in level of cross reactivity

Aztreonam - option unless ceftazidime-allergic

147
Q

how do we go about dosing in a pt w/ a PCN allergy where a beta-lactam is a MUST?

A

Give test dose ( 1/10th of full dose)

Desensitization

148
Q

where are FQs concentrated in the body?

A

Widely distributed in extracellular and intracellular fluids

and are concentrated in prostate, lungs, bile

149
Q

how are FQs metabolized

A

in liver and excreted in urine

Moxifloxacin is eliminated in the bile

150
Q

FQ MOA

A

concentration dependent bactericidal activity by inhibiting the activity of DNA gyrase and topoisomerase enzymes essential for bacterial DNA replication

151
Q

what are the respiratory fluoroquinolones

A

Levofloxacin and Moxifloxacin

152
Q

macrolide MOA

A

Primarily Bacteriostatic, by binding to the 50S subunit of the ribosome, they inhibit bacterial protein synthesis.

Relatively poorly absorbed orally

153
Q

where do tetracyclines penetrate w/in the bodt

A

Penetrate most body tissues and fluids, concentrated in unobstructed bile.

Does not reach CSF fluids.

Minocycline reaches highest concentration in tears and saliva.

154
Q

Abx that

Covers Anaerobes ONLY (gram positive and negative - “gold standard”)

A

Metronidazole (flagyl)

c. diff
b. fragillis

155
Q

where is bactrim found in the body

A

Mostly absorbed from GI Tract, Highly concentrated in urine

Binds to serum albumin

156
Q

what abx is not well absorbed in GI Tract but can be used with Ulcerative Colitis and Inflammatory Bowel Disease because GUT flora metabolize into two compounds

157
Q

Vanco is (bactericidal / static) by inhibiting cell wall synthesis and (is/ is not) readily absorbed in GI tract

A

bactericidal

is NOT

158
Q

where does IV vanco penetrate ?

A

penetrates the bile, pleural, pericardial, synovial and ascetic fluids. Doesn’t easily get to CSF.

159
Q

MOA of Lincosamides, Oxazolidinones, and Streptgramins

A

similar action and cover the same bacteria.

Similar to Macrolides, they inhibit protein synthesis by binding to 50S ribosomal subunit.

160
Q

does clinda or linezolid have gram - coverage?

161
Q

Good choice for Vanco resisteant staph and MRSA???

A

Daptomycin

162
Q

MOA of daptomycin

A

Cyclic lipopeptide that binds to cell membranes causing rapid depolarization of membrane due to potassium efflux and disruption of the DNA, RNA and protein synthesis.

163
Q

aminoglycoside MOA

A

Bactericidal antibiotics that bind to 30S ribsome and inhibit protein synthesis.

conc dependent

164
Q

“Post Antibiotic Effect”

A

Residual bactericidal activity persists even after the serum concentration has fallen below the MIC (drug remains intracellular)

165
Q

where is daptomycin absorbed

A

Poorly absorbed orally but well absorbed in peritoneum, pleural cavity and joints

166
Q

what abx is given in intravitreous injections for endopthalmitis

A

Aminoglycosides

167
Q

Aminoglycosides are only used as single agents with _____ and ______.

A

plague and Tuleremia

168
Q

aminoglycosides that cover pseudomonas

A

(amikacin > tobramycin > gentamicin)

169
Q

aminoglycoside syngery for gram (positive or negative)

A

Gram positive (aerobic, never used as monotherapy)

Synergy - “amp and gent”
Streptomycin in combo with beta-lactams - endocarditis

170
Q

Unlike most inhibitors of microbial protein synthesis, which are (bacteriocidal /static) , the aminoglycosides are bactericidal /static).

A

most antimicrobials bacteriostatic

aminoglycosides ARE bactericidal

171
Q

Used primarily to treat infections caused by aerobic gram-negative bacteria (including Pseudomonas)

A

aminoglycosides

172
Q

does RIFAMPIN penetrate CSF?

A

yes - tx TB

173
Q

rifampin MOA

A

Bactericidal antibiotics that inhibits RNA polyermase, suppressing RNA synthesis.

174
Q

FOSFOMYCIN MOA

A

Bactericidal antibiotics that inhibits cell wall synthesis.

175
Q

fosfomycin penetration?

A

Bladder is the only site where there is adequate concentration of the drug and therefore used only for UTIs

176
Q

fosfomycin coverage

A

Coverage against MSSA, MRSA, VRE, VSE, and Pseudomonas

177
Q

FIDAXOMICIN MOA

A

Prohibits RNA polymerase, thereby preventing transcription.

178
Q

Abx use is a major risk factor for C. diff:

Especially administration > ___ antibiotics

Risk of CDI doubles after ___ days of antibiotic therapy

A

> 3 abx

3 days

Clinical Management exam I (4 decks)

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