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Step 1 - Microbiology > Antibiotics & Antiparasitics > Flashcards

Antibiotics & Antiparasitics Flashcards

1
Q

Penicillin overview

A
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2
Q

Clinical Indications for Penicillins

A

Gram Positive organisms & some Gram Negative
1. Group B strep (Strep Agalactiae)
2. Actinomyces
2. Neisseria meningitidis - gram negative diplococci
3. Treponema pallidum (Syphilis) - spirochetes

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3
Q

Acute interstitial nephritis

A

Inflammation of the renal tubules. Rise in creatinine/BUN
* also associated with high eosinophil count on blood work

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4
Q

Penicillinase-sensitive penicillins

Broad spectrum

A
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5
Q

Penicillinase-resistant penicillins

Narrow spectrum

A
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6
Q

Anti-Pseudomonal penicillins

Piperacillin/Tazobactam

A
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7
Q

Cephalosporins - overview

  • Resistant to the penicillinase enzymes
A
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8
Q

Cephs (class) - adverse effects

A
  1. Hypersensitivity
  2. Autoimmune hemolytic anemia
  3. Disulfiram-like reaction to alcohol
  4. Vitamin K deficiency
  5. Increased synergistic nephrotoxicity with AMGs
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9
Q

1st Gen Cephs

  • Zolin & Lexin
  • Gram positive cocci (Staph & Strep)
  • Surgical prophylaxis
A
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10
Q

2nd Gen Cephs

  • Gram positive cocci (Staph & Strep)
  • Surgical prophylaxis
A
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11
Q

3rd Gen Cephs

  • Both gram positive & gram negative infections
  • Triaxone & Tazidime
A
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12
Q

4th Gen Cephs

A
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13
Q

5th Gen Cephs

  • CefTAROLINE
A
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14
Q

Which Cephalosporin should I prescribe for pseudomonas aeruginosa infection?

A
  1. Ceftazidime (3rd gen ceph)
  2. Cefepime (4th gen ceph)
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15
Q

Which Cephalosporin should I prescribe for neisseria gonorrhea infection?

A
  1. Ceftriaxone (3rd gen ceph)
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16
Q

Which Cephalosporin should I prescribe for MRSA infection?

A
  1. Ceftaroline (5th gen ceph)
    * ^ Reserved for multidrug resistant bacteria
    * Not effective against pseudomonas
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17
Q

Carbapenems

  • Not susceptible to penicillinases
A
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18
Q

Monobactams (Aztreonam)

  • Gram negative rods only
  • Used in patients with a penicillin allergy
  • Used in patients with renal insufficiency who cannot tolerate AMGs
A
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19
Q

Vancomycin

  • MRSA
  • Top 3 adverse: Red man syndrome, nephrotoxicity, & ototoxicity
A
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20
Q

Carbapenems are typically used as what?

A

The last line of defense against particularly tough bacterial infections

Resistance in the following organisms:
1. Klebsiella pneumoniae
2. E. coli
3. Klebsiella aerogenes

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21
Q

Aminoglycosides

  • Targets aerobic bacteria – requires O2 for uptake
  • 30s subunit of bacterial ribosomes
A
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22
Q

Patient who is taking both a loop diuretic (furosemide) & and an aminoglycoside, be sure to look out for these serious adverse effect:

A

Ototoxicity

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23
Q

Which population are AMGs contrainidicated in?

A

Patients with myasthenia gravis, due to the neuromuscular blockade adverse effect?

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24
Q

Tetracyclines (part 1)

  • Particularly powerful against intracellular agents (Rickettsial diseases, Chlamydia, Mycoplasma pneumonia, Lyme (Borrelia))
A
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25
Q

Tetracyclines (part 2)

A
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26
Q

Tigecycline

A
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27
Q

Do NOT ingest what food/medication products with Tetracyclines?

A

Milk, antacids, and iron-containing products!!
* Lowers the bioavailability

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28
Q

Name that drug class: Pediatric patient with discolored teeth, inhibited bone growth, and photosensitive rashes (“easy sunburns”)

A

Tetracyclines

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29
Q

When is Tigecycline used?

A

It’s used as a last resort against MDR organisms

30
Q

Watch out for this serious adverse effect in a patient that was just started on Tigecycline:

A

Bleeding
* Reduces fibrinogen levels in the blood (prolongs clotting time)
* Bleeding risk is dose-dependent
* Clinically an important cause of mortality in patients taking this Rx
* Main reason it is a last-resort drug
* Labs: sudden drop in hematocrit & RBC counts

31
Q

Chloramphenicol

  • Binds 50s subunit of bacterial ribosomes
32
Q

Why should you avoid giving chloramphenicol to pediatric patients under the age of 2?

A

Gray baby syndrome
* UDP-gluc enzyme is lacking – so drug accumulates to toxic levels

Clinical Sx
1. Gray skin
2. Vomiting
3. Lethargy
4. Cardiorespiratory depression

33
Q

Clindamycin

34
Q

What is the most common antibiotic associated with pseudomembranous colitis & C. diff?

A

Clindamycin

35
Q

Linezolid

35
Q

Fun little saying for Clindamycin & Metronidazole

A
  • “Clindamycin above the diaphragm”
  • “Metronidazole below the diaphragm”
36
Q

Name that drug: last resort treatment for gram-positive species MDR infections:

A host of bad side effects

A

Linezolid
* MRSA
* VRE (vancomycin-resistant enterococcus)

37
Q

Which antibiotic can cause serotonin syndrome, especially when combined with MAOIs and SSRIs?

High yield !!

38
Q

Macrolides

39
Q

High yield side effects of macrolides:

A
  1. Acute hepatitis
  2. GI upset
  3. Torsade de Pointes
  4. Drug interactions (via CYP450 enzyme inhibition)
40
Q

Polymixins

41
Q

Polymyxin top 3 adverse:

A
  1. Nephrotoxicity
  2. Neurotoxicity
  3. Respiratory failure (via neurotox damage of phrenic nerve)
42
Q

Sulfonamides

43
Q

Top 6 adverse in Sulfonamides:

A
  1. Sulfa allergy (Type 1 HS)
  2. Hemolysis w/ G6PD deficiency
  3. Nephrotoxicity
  4. Photosensitive rash (potential for SJS)
  5. Inhibition of CYP enzymes (rx interactions)
  6. Infantile kernicterus
44
Q

Dapsone

45
Q

Top 3 adverse of Dapsone:

A
  1. Hemolysis in G6PD – dropping RBC counts and pallor/fatigue (anemia)
  2. Methemoglobinemia – hypoxia & lactic acidosis
  3. Agranulocytosis – dropping PMN counts (bone marrow failure)
46
Q

Trimethoprim

47
Q

Fluoroquinolones

48
Q

What OTC med should Fluoroquinolones not be taken with?

A

Antacids
* Reduces oral absorption of the drug

49
Q

Interesting adverse effects of Fluoroquinolones (as a class):

A
  1. Tendonitis & Tendon rupture
  2. Teratogen
  3. Teeth & bone defects in children
  4. Cardiac QT prolongation (Torsade de Pointes)
50
Q

What is a unique trait of Ciprofloxacin, as compared to other Fluoroquinolones?

A

It inhibits CYP450 enzymes
* This causes drug interactions (warfarin, theophylline, etc.)

51
Q

Contraindicated population groups for Fluoroquinolones?

A
  1. Children
  2. Pregnant women
52
Q

Daptomycin

53
Q

Metronidazole

  • Anaerobic pathogens
54
Q

Which antibiotic causes a metallic taste in the mouth and a disulfiram-like reaction to alcohol?

A

Metronidazole

55
Q

Rifamycins
* Rifampin
* Rifabutin

56
Q

Which antibiotic causes red-orange discoloration of body fluids (harmless)?

A

Rifampin
* Also Rx interactions, hepatotoxicity, and neprhotoxicity

57
Q

Top 3 uses for Rifamycins:

A
  1. Mycobacterium (TB, leprosy, avium)
  2. N. meningitidis
  3. H. flu type b
58
Q

Why is Rifabutin the rifamycin of choice in HIV patients or patients taking warfarin?

A

Because Rifampin (the other rifamycin) induces CYP450 enzymes affecting
* warfarin
* theophylline
* protease inhibitors in HIV

60
Q

Isoniazid

61
Q

Are side effects more or less common in slow acetylators taking Isoniazid?

A

Slow acetylators

62
Q

Isoniazid - top adverse effects

A
  1. Vitamin B6 (pyridoxine) deficiency
  2. Drug interactions (CYP450 inhibition)
  3. Lupus-like reaction (drug-induced)
  4. Hepatoxicity
  5. Anion gap metabolic acidosis
63
Q

Pyrazinamide

64
Q

The risk of this synergistically created adverse effect is common in patients between treated for active TB with the RIPE regimen:

A

Hepatoxicity

65
Q

Ethambutol

66
Q

Name that drug: a patient being treated for TB (RIPE regimen) who now is experiencing the following vision changes:
1. Red-green color blindness
2. Decreased visual acuity
3. Central scotoma

A

Ethambutol
* Vision changes are reversible with the discontinuation of this drug

67
Q

Chloroquine

68
Q

P. falciparum (chloroquine-resistant)

A

Rx combo - Chloroquine &
1. Artemisins
2. Atovaquone-proguanil
3. Mefloquine

69
Q

P. vivax & ovale

A

Chloroquine & Primaquine
* To kill the hypnozoites

Step 1 - Microbiology (10 decks)

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