antibiotics Flashcards
1
Q
Name the naturally occurring PCNs and their ROI.
A
Penicillin VK (PO) Penicillin G (IV or IM)
2
Q
Name the Anti-staphylococcal PNCNs.
A
Dicloxacillin (PO)
Nafcillin (IV)
Oxacillin (IV)
3
Q
Name the Aminopenicillins
A
Amoxicillin (PO)
Ampicillin (IV)
4
Q
Name the Antipseudomonal penicillins
A
Piperacilline (IV)
Ticarcillin
5
Q
Name the two Beta-lactamase/PNCN combo
A
Zosyn (antipseudomonal)
Unasyn (anti-Acinetobacter)
6
Q
what are first line abx in tx MSSA?
A
Dicloxacillin (PO)
Nafcillin (IV)
Oxacillin (IV)
(Anti-staphylococcal PNCNs)
7
Q
what would we use to tx Syphilis ?
A
Pen G
8
Q
*only PCN doesn’t require renal dosing??
A
Dicloxacillin
Nafcillin
Oxacillin
9
Q
describe the coverage of Anti-Staphylococcal
PCNs (diclox, naf, oxa)
A
GREAT MSSA COVERAGE
Broader gram + coverage
10
Q
gold standard for tx of listeria
A
ampicillin
11
Q
what would you prescribe Amoxicillin for?
A
Otitis media
UTIs/URIs
Meningitis (ampicillin)
12
Q
describe coverage for ampicillin/amox
A
PCN + added Gram negative coverage (E. coli, H. flu, salmonella)
Enterococcus
Listeria and Shigella (Ampicillin preferred)
13
Q
β-lactam + β-lactamase Inhibitors include zosyn and unasyn among others, which of the 2 is equivalent to augmentin PO?
A
unasyn
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
15
Q
β-lactam + β-lactamase Inhibitors include zosyn and unasyn among others, which of the 2 is used to tx Acinetobacter?
A
unasyn
16
Q
what would you use to tx Human bites + Animal Bites
A
augmentin
17
Q
Name the 1st gen cephs?
A
Cefazolin (Ancef) (IV)
Cephalexin (Kelfex) (PO)
Cefadroxil (Duracef) (PO
18
Q
Name the 2nd gen cephs (2A)
A
Cefuroxime (Ceftin)
Cefaclor
Cefprozil
19
Q
Name the 2nd gen cephs (2B)
A
Cefoxitin
Cefotetan
20
Q
Name the 3rd gen cephs
A
Anti-pneumococcal Cefotaxime Ceftriaxone Cefixime Cefpodoxime
Antipseudomonal
Ceftaz
21
Q
name 4th gen cephs
A
Cefepime IV
22
Q
name 5th gen cephs
A
Ceftaroline IV
23
Q
name the abcx prescribes SECOND line for MSSA infection?
A
1st gen cephs
Cefazolin (Ancef) (IV)
Cephalexin (Kelfex) (PO)
Cefadroxil (Duracef) (PO
24
Q
what would we use 1st gen cphs to tx?
A
Skin infections SECOND line for MSSA SSTI UTI Pre-op abx
25
Out of the cephalosporins what would tx?
Respiratory tract infections
Sinusitis, otitis, etc
2nd gen (2A)
Cefuroxime (Ceftin)
Cefaclor
Cefprozil
26
Out of the cephs what covers:
Skin infections
MRSA / VRSA
VSE
CeftarolineIV (5th gen)
gram +/- aerobes
27
out of the cephalosprins which cover pseudomonas?
3rd gen antipseudo -> ceftaz
4th gen -> Cefepime (IV)
28
name the Anti-pneumococcal cephs
Cefotaxime
Ceftriaxone
Cefixime
Cefpodoxime
29
what would we prescribe for tx of Gonorrhea ?
Gonorrhea (ceftriax)
30
what would we prescirbe if their was an infection due to b. fragillis
2B
Cefoxitin
Cefotetan
31
what ceph covers: gram -
Abdominal infections
GYN infections
includes b.fragilis !!
Cefoxitin
Cefotetan
32
what could we use ceftaz to tx
HA pneumonia
33
what would we use to tx Neutropenic fever
Cefepime (Maxipime)
34
name the carbapenems
Primaxin (imipenem/cilastatin)
Meropenem
Doripenem
Ertapenem
35
Drug of choice for ceftriaxone-resistant E. coli
carbapenems:
Primaxin (imipenem/cilastatin)
Meropenem
Doripenem
Ertapenem
36
Name ADRs of carbapenems
Highest risk of seizures
Carbapenem resistant Enterobacteriaceae (CRE)
Expensive
37
coverage of carbapenems
gram +/- aerobes
38
name things carbapenems tx:
```
Ceftriaxone resistant E. coli
Klebsiella
ESBL
Complicated UTI
Intraabdominal infection
```
39
name coverage of vanco
Gram (+) aerobes & anaerobes
40
what are indications for using vanco IV
```
Hospital acquired pneumonia
Skin infections (MRSA)
```
41
why would you usevanco PO?
tx C. diff - PO
42
name ADRs of vano
Red-man syndrome
Ototoxicity/ nephrotox
C/I in corn hypersensitivity
Dosing renal & weight adjusted
43
what is VERY important in putting in your order when dosing vanco
TDM of trough – order 30 min before 4th dose
44
Name the tetracyclines
Doxycycline (IV or PO)
Tetracycline
Minocycline
45
indications for tetracyclines:
Respiratory tract infections
Skin infections (MRSA)
Tick-bourne infections
46
coverage of tetracyclines
Strep
Staph (MSSE, MRSA)
Neisseria sp. (gram (-))
Atypicals (ex. lyme. Mycoplasma, chlamydia)
47
ADRs of tetracyclines
```
CI in children under 8
avoid in pregnancy
Drug intx w/ Ca, Fe, Mg Al
Metabolized in liver
GI sensitivity
Photosensitivity
```
48
what class of dugs has Black box warning for causing tendinopathies (elderly and young)
FQs
49
what classes of drugs decrease seizure threshold and should be avoided in pts who experience seizures?
FQs
| Carbapenems
50
FQs can tx UTIs EXCEPT:
Moxifloxacin (no gram-)
51
FQs can tx resp. tract infections EXCEPT
Ciprofloxacin (no gram +)
52
indications for prescribing FQs
UTI (except moxi)
Respiratory tract infections (except cipro)
Intrabdominal infections
Osteomyelitis
53
```
drug class w/ ADRS including:
Hypoglycemia/hyperglycemia
Delirium in the elderly (mental status change)
QTc prolongation
```
FQs
54
coverage of FQs
Gram (+) (except cipro)
Gram (-) (except moxi)
Atypical – chlamydia, legionella, mycoplasma
Enterobacteriaceae – H.flu M. cat, Niserria
55
which class of abx is known to have EXCELLENT atypical coverage?
FQs
56
what FQs could we use to tx M. tuberculosis
moxi
| levo
57
whoch abx has an ADR of possible causing C. Difficile/ diarrhea
clinda
58
what abx could we use to tx NF
clinda
59
coverage of clinda
Strep
Staph (MSSA, MRSA)
Gram (+) anaerobes – w/ PSN allergy
60
name some indications for prescribing clinda
```
Skin infections (CA-MRSA)
Dental infections
Respiratory tract infections
Nec fash
Pregnant women colonized w/ MRSA
```
61
name macrolide abx
Azithromycin (IV or PO)(Z-pak)
| Erythromycin (IV or PO)
62
tx of AOM, pharyngitis in PCN allergy
macrolide (azith/eryth)
63
coverage of macrolides
Group A strep
GNR – H. flu, M/ cat, Neisseria
Atypicals – chlamydia, legionella, m. pneumonia
64
what class of abx are NEVER USED for: SEPSIS, urine or soft tissue infections
macrolide
65
ADRs of macrolides
```
QTc prolongation (risk of sudden cardiac death)
Liver metabolized
```
66
macrolides are used to tx respiratory tract infections, pharyngitis in PCN allergy and what else? (2 things)
Chlamydia
| Travelers diarrhea
67
what abx is indicated for coverage of
Anaerobes (b. fragilis + c. diff)
Parasites
Metronidazole (flagyl)
68
FIRST line for tx of c. diff
Metronidazole (flagyl)
69
indications to prescribes Metronidazole (flagyl)
Intra-abdominal infections
C. diff – FIRST line
Vaginosis
70
____________ is often added to other abx when treating intraabdominal infections
Metronidazole (flagyl)
71
ADRs of Metronidazole (flagyl)
Should not take with alcohol (disulfiram-like reaction)
GI intolerance
Metallic taste
periph. neuropathy
72
Bactrim is dosed based on the _______ component
trimethoprim
73
name the abx used to tx opportunistic infections?
name some opportunistic infections
bactrim
| pneumocystitis, nocardia, toxoplasmosis
74
coverage of bactrim
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
indications for bactrim
UTIs
Skin and soft tissue infections
```
Opportunistic infections (pneumocystitis, nocardia, toxoplasmosis)
Plasmodium
```
76
does bactrim cover atypicals or pseudomonas?
NO!
Strep
Staph (MSSA, MRSA)
Gram (-) aerobes
77
name some ADRs of bactrim
```
Hyperkalemia
Drug interaction w/ warfarin & phenytoin (INR)
Renal dosing
Avoid in pregnancy
Photosensitivity
Bone marrow suppression
```
78
______ has a drug interaction w/ warfarin & phenytoin so we should ALWAYS order an INR!!!
bactrim
79
abx to avoid in pregnancy
bactrim
tetracyclines
FQs
80
why should we avoid bactrim in pregnancy?
causes bone marrow suppression
81
name abx where we must monitor trough levels
vanco
| Aminoglycosides (gentamycin)
82
ADRS of Aminoglycosides
Acute kidney injury (nephrotoxic)
| Ototoxic
83
name the aminoglycosides
```
Amikacin (IV)
Gentamicin
Tobramycin
Plazomicin
Streptomycin
```
84
second line tx of TB?
aminoglycosides - Streptomycin
85
```
class of abx that has:
Excellent Gram negative coverage including P. aeruginosa along with
Synergy against Gram positives
```
aminoglycosides
86
indications for prescribing aminoglycosides
Hospital-acquired infections
Endocarditis
TB
87
Aminoglycosides are NOT often used alone except for treating ____?
UTIs
88
ADRs for aminoglycosides
nephrotoxicity
| MONITOR trough levels
89
what abx are urinary antiseptics
Nitrofurantoin
(Macrobid; Macrodantin)
Fosfomycin (Monurol)
90
_______ typically drug of choice to tx UTIs in pregnancy (except after week 38)
Nitrofurantoin
91
Nitrofurantoin (does /does not??) penetrate ureters.
DOES NOT penetrate ureters
limited to lower UTI infections
92
coverage of Nitrofurantoin
Enterococcus (VSE & VRE)
GNR
E. coli
93
ADRs of Nitrofurantoin
CrCl <60 ml/min (RENAL DOSE)
Hepatotoxicity
Pulmonary toxicity
Neuropathy
94
what abx covers:
Gram (+) aerobes & anaerobes ONLY
MRSA/ VRE
and DOES NOT need to be renally dosed?
Linezolid
95
ADRS of what abx?
Serotonin syndrome
HTN crisis
Tyramine-containing foods
Thrombocytopenia
Linezolid
96
indications for prescribing linezolid
Pneumonia
Skin infections
Bacteremia/sepsis
MRSA in SEVERLY compromised kidneys
97
what do we prescribe for MRSA in SEVERLY compromised kidneys
Linezolid
98
what abx cannot be used in pneumonia?
daptomycin
| binds to lung surfactant
99
coverage of daptomycin
Gram positives only (including MRSA and VRE)
100
ADRs of daptomycin
Myalgia
Neuropathy
elevation in CPK
Rhabdomyolysis
101
indications for prescribing daptomycin
Skin infections
Bacteremia
Endocarditis
Osteomyelitis
102
besides vanco PO what abx is ONLY used for c. diff?
Fidaxomicin (Dificid) (PO)
103
Fidaxomicin (Dificid) has a _____ fecal concentration and _____ serum concentration.
high fecal
| low serum
104
One dose of _____ lasts 72-84 hours in bladder!
Fosfomycin (PO)
105
coverage of Fosfomycin
Enterococcus (VSE, VRE)
Staphylococcus (MSSA, MRSA)
GNR
Pseudomonas
106
indications for Fosfomycin
UTI – recurrent
| Cystitis
107
indications for Nitrofurantoin
UTI – in pregnant women
Chronic UTI suppression
Cystitis
108
what would we avoid FQs in children?
avoid in young children due to risk of inappropriate formation of cartilage
109
Seizures: Risk with all beta-lactams if inappropriately adjusted for _____ function
renal
110
abx that are Hepatotoxic
nafcillin
oxacillin
fluoroquinolones,
111
Macrolides (_________): risk of sudden cardiac death, ___ ______
azithro
| Qtc prolongation
112
beta-lactams with highest seizure risk
Cefepime
Fluoroquinolones
Carbapenems
113
class of abx that cause QTC prolongation
FQs
| macrolides (azithro)
114
what ADR are we most worries about w/ daptomycin? (think what increases?)
increased CK (rhabdomyolysis)
115
abx casuing photosensitivity
tetracyclines
| bactrim
116
Tx for c. diff
Metronidazole (flagyl) IV or PO
Vancomycin PO only
```
alternatives:
clinda
ampicillin
amoxicillin
FQs
cephs
```
117
VSE UTI susceptible options
Nitrofurantoin
fosfomycin
Amoxicillin
amoxicillin/clavulanic acid
Doxycycline
118
VSE Infections Parenteral – susceptible enterococci
Ampicillin (Gold standard)
Penicillin G
Vancomycin
+/- Gentamicin depending on illness severity
119
abx for VRE
Daptomycin
Linezolid
Tigecycline
Telavancin
May use any of the VSE if susceptibility indicates
120
PO options for MRSA
Bactrim DS
Clindamycin
Tetracyclines
Linezolid
121
IV options for MRSA
```
Vancomycin
Daptomycin
Linezolid
Tigecycline
Telavancin
Ceftaroline
```
122
abx cover pseudomonas
Beta-lactams
Piperacillin/Tazo (Zosyn)
Ceftazadime
Cefepime
Fluoroquinolones (except moxifloxacin)
Aminoglycosides
123
abx that cover atypicals
Macrolides
tetracyclines
FQs
124
indication for rifampin
TB - absorbed in CSF
MSSA
MRSA
125
coverage of rifampin
```
Gram + (some gram -)
MSSA
MRSA
haemophilus
neisseria meningitis
```
126
ADR rifampin
myalgia
arthralgia
hyperbilirubinemia
127
Time-dependent killing
exert optimal bactericidal effect when drug concentrations are maintained above the MIC.
Higher frequency of dosing.
b-lactams
128
Concentration-dependent killing
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
AUC:MIC
vanco
130
Time Dependent Drugs should be dosed ___ per day.
3-4 times per day
Beta-lactam antibiotics, such as penicillins and cephalosporins
131
Concentration Dependent Drugs should be dosed ___ per day.
once- or twice-daily dosing is optimal, to ensure high peak concentrations.
Aminoglycosides and fluoroquinolones
132
Synergistic drug combo to treat complicated MSSA
nafcillin + gentamicin
133
____+_____ use is often reserved for prosthetic valve endocarditis or prosthetic joint infections
nafcillin + gentamicin
134
abx with no dosing adjustments needed
Ceftriaxone
nafcillin
oxacillin
linezolid
135
MOA of beta-lactams
MOA: Inhibits Penicillin Binding Proteins (PBPs )
Inhibits the cross-linking of peptidoglycan.
Prevents the development of bacterial cell wall.
136
beta lactams are (concentration / time) dependent and (bactericidal / bacterialstatic) except for _____.
times
Bactericidal
Enterococcus
137
how are most beta lactams eliminated?
Most are renally eliminated
Except: nafcillin, oxacillin, ceftriaxone
138
Pcn – resistance (2 ways)
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
how to overcome Streptococcus pneumoniae resistance
high dose amoxicillin
| switch to cephalosporin or other agent
140
Method to overcome beta-lactamase enzymes
Beta Lactamase Inhibitors
141
MOA of Beta Lactamase Inhibitors
Inhibit some, but not all beta-lactamases
Binds to beta-lactamase, i.e. suicide gene
Prevents the destruction of the parent drug
142
Most common mechanism of resistance that typically occurs with gram negative organism
beta-lactamase enzymes overcome w beta-lactamase inhibitors
Clavulanic Acid + Amoxicillin (Augmentin)
Sulbactam + Ampicillin (Unasyn)
Tazobactam + Piperacillin ( Zosyn)
143
it is important to note that Beta Lactamase Inhibitors DO NOT TREAT?
EXTENDED SPECTRUM BETA-LACTAMASES (ESBL) ENTEROBACTERIACIAE.
144
when treating otitis media what is the antibiotic with additional beta-lactamase coverage recommended if child has already received amoxicillin in past 30 days?
amoxicillin-clavulanate
145
cephalosporins MOA
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
Rash w/ PCN what is the thought process when prescribing?
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
how do we go about dosing in a pt w/ a PCN allergy where a beta-lactam is a MUST?
Give test dose ( 1/10th of full dose)
Desensitization
148
where are FQs concentrated in the body?
Widely distributed in extracellular and intracellular fluids
and are concentrated in prostate, lungs, bile
149
how are FQs metabolized
in liver and excreted in urine
Moxifloxacin is eliminated in the bile
150
FQ MOA
concentration dependent bactericidal activity by inhibiting the activity of DNA gyrase and topoisomerase enzymes essential for bacterial DNA replication
151
what are the respiratory fluoroquinolones
Levofloxacin and Moxifloxacin
152
macrolide MOA
Primarily Bacteriostatic, by binding to the 50S subunit of the ribosome, they inhibit bacterial protein synthesis.
Relatively poorly absorbed orally
153
where do tetracyclines penetrate w/in the bodt
Penetrate most body tissues and fluids, concentrated in unobstructed bile.
Does not reach CSF fluids.
Minocycline reaches highest concentration in tears and saliva.
154
Abx that
| Covers Anaerobes ONLY (gram positive and negative - “gold standard”)
Metronidazole (flagyl)
c. diff
b. fragillis
155
where is bactrim found in the body
Mostly absorbed from GI Tract, Highly concentrated in urine
Binds to serum albumin
156
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
bactrim
157
Vanco is (bactericidal / static) by inhibiting cell wall synthesis and (is/ is not) readily absorbed in GI tract
bactericidal
is NOT
158
where does IV vanco penetrate ?
penetrates the bile, pleural, pericardial, synovial and ascetic fluids. Doesn’t easily get to CSF.
159
MOA of Lincosamides, Oxazolidinones, and Streptgramins
similar action and cover the same bacteria.
Similar to Macrolides, they inhibit protein synthesis by binding to 50S ribosomal subunit.
160
does clinda or linezolid have gram - coverage?
NO
161
Good choice for Vanco resisteant staph and MRSA???
Daptomycin
162
MOA of daptomycin
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
aminoglycoside MOA
Bactericidal antibiotics that bind to 30S ribsome and inhibit protein synthesis.
conc dependent
164
“Post Antibiotic Effect”
Residual bactericidal activity persists even after the serum concentration has fallen below the MIC (drug remains intracellular)
165
where is daptomycin absorbed
Poorly absorbed orally but well absorbed in peritoneum, pleural cavity and joints
166
what abx is given in intravitreous injections for endopthalmitis
Aminoglycosides
167
Aminoglycosides are only used as single agents with _____ and ______.
plague and Tuleremia
168
aminoglycosides that cover pseudomonas
(amikacin > tobramycin > gentamicin)
169
aminoglycoside syngery for gram (positive or negative)
Gram positive (aerobic, never used as monotherapy)
Synergy - “amp and gent”
Streptomycin in combo with beta-lactams - endocarditis
170
Unlike most inhibitors of microbial protein synthesis, which are (bacteriocidal /static) , the aminoglycosides are bactericidal /static).
most antimicrobials bacteriostatic
aminoglycosides ARE bactericidal
171
Used primarily to treat infections caused by aerobic gram-negative bacteria (including Pseudomonas)
aminoglycosides
172
does RIFAMPIN penetrate CSF?
yes - tx TB
173
rifampin MOA
Bactericidal antibiotics that inhibits RNA polyermase, suppressing RNA synthesis.
174
FOSFOMYCIN MOA
Bactericidal antibiotics that inhibits cell wall synthesis.
175
fosfomycin penetration?
Bladder is the only site where there is adequate concentration of the drug and therefore used only for UTIs
176
fosfomycin coverage
Coverage against MSSA, MRSA, VRE, VSE, and Pseudomonas
177
FIDAXOMICIN MOA
Prohibits RNA polymerase, thereby preventing transcription.
178
Abx use is a major risk factor for C. diff:
Especially administration > ___ antibiotics
Risk of CDI doubles after ___ days of antibiotic therapy
>3 abx
| 3 days
