Antibiotics & Antiparasitics Flashcards
1
Q
Penicillin overview
A
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
3
Q
Acute interstitial nephritis
A
Inflammation of the renal tubules. Rise in creatinine/BUN
* also associated with high eosinophil count on blood work
4
Q
Penicillinase-sensitive penicillins
Broad spectrum
A
5
Q
Penicillinase-resistant penicillins
Narrow spectrum
A
6
Q
Anti-Pseudomonal penicillins
Piperacillin/Tazobactam
A
7
Q
Cephalosporins - overview
- Resistant to the penicillinase enzymes
A
8
Q
Cephs (class) - adverse effects
A
- Hypersensitivity
- Autoimmune hemolytic anemia
- Disulfiram-like reaction to alcohol
- Vitamin K deficiency
- Increased synergistic nephrotoxicity with AMGs
9
Q
1st Gen Cephs
- Zolin & Lexin
- Gram positive cocci (Staph & Strep)
- Surgical prophylaxis
A
10
Q
2nd Gen Cephs
- Gram positive cocci (Staph & Strep)
- Surgical prophylaxis
A
11
Q
3rd Gen Cephs
- Both gram positive & gram negative infections
- Triaxone & Tazidime
A
12
Q
4th Gen Cephs
A
13
Q
5th Gen Cephs
- CefTAROLINE
A
14
Q
Which Cephalosporin should I prescribe for pseudomonas aeruginosa infection?
A
- Ceftazidime (3rd gen ceph)
- Cefepime (4th gen ceph)
15
Q
Which Cephalosporin should I prescribe for neisseria gonorrhea infection?
A
- Ceftriaxone (3rd gen ceph)
16
Q
Which Cephalosporin should I prescribe for MRSA infection?
A
-
Ceftaroline (5th gen ceph)
* ^ Reserved for multidrug resistant bacteria
* Not effective against pseudomonas
17
Q
Carbapenems
- Not susceptible to penicillinases
A
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
19
Q
Vancomycin
- MRSA
- Top 3 adverse: Red man syndrome, nephrotoxicity, & ototoxicity
A
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
21
Q
Aminoglycosides
- Targets aerobic bacteria – requires O2 for uptake
- 30s subunit of bacterial ribosomes
A
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
23
Q
Which population are AMGs contrainidicated in?
A
Patients with myasthenia gravis, due to the neuromuscular blockade adverse effect?
24
Q
Tetracyclines (part 1)
- Particularly powerful against intracellular agents (Rickettsial diseases, Chlamydia, Mycoplasma pneumonia, Lyme (Borrelia))
A
25
Tetracyclines (part 2)
26
Tigecycline
27
Do **NOT ingest** what food/medication products with **Tetracyclines**?
**Milk**, **antacids**, and **iron-containing products**!!
* Lowers the bioavailability
28
**Name that drug class**: Pediatric patient with **discolored teeth**, **inhibited bone growth**, and **photosensitive rashes** ("easy sunburns")
Tetracyclines
29
When is **Tigecycline** used?
It's used as a **last resort** against **MDR** organisms
30
Watch out for this **serious adverse effect** in a patient that was just started on **Tigecycline**:
**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
Chloramphenicol
## Footnote
* Binds **50s subunit** of **bacterial ribosomes**
32
Why should you **avoid** giving **chloramphenicol** to pediatric patients **under the age of 2**?
**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
Clindamycin
34
What is the most common **antibiotic** associated with **pseudomembranous colitis** & **C. diff**?
Clindamycin
35
Linezolid
35
Fun little saying for **Clindamycin** & **Metronidazole**
* "**Clindamycin above** the diaphragm"
* "**Metronidazole below** the diaphragm"
36
**Name that drug**: last resort treatment for **gram-positive species MDR infections**:
## Footnote
A host of bad side effects
**Linezolid**
* **MRSA**
* **VRE** (vancomycin-resistant enterococcus)
37
Which antibiotic can cause **serotonin syndrome**, especially when combined with **MAOIs** and **SSRIs**?
## Footnote
High yield !!
Linezolid
38
Macrolides
39
High yield side effects of **macrolides**:
1. **Acute hepatitis**
2. **GI** upset
3. **Torsade de Pointes**
4. **Drug interactions** (via CYP450 enzyme inhibition)
40
Polymixins
41
**Polymyxin** top 3 adverse:
1. **Nephrotoxicity**
2. **Neurotoxicity**
3. **Respiratory failure** (via neurotox damage of *phrenic nerve*)
42
Sulfonamides
43
Top 6 adverse in **Sulfonamides**:
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
Dapsone
45
Top 3 adverse of **Dapsone**:
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
Trimethoprim
47
Fluoroquinolones
48
What OTC med should Fluoroquinolones not be taken with?
**Antacids**
* Reduces oral absorption of the drug
49
Interesting **adverse** effects of **Fluoroquinolones** (as a class):
1. **Tendonitis** & **Tendon rupture**
2. Teratogen
3. **Teeth & bone defects** in children
4. Cardiac **QT prolongation** (Torsade de Pointes)
50
What is a **unique** trait of **Ciprofloxacin**, as compared to other **Fluoroquinolones**?
It **inhibits CYP450 enzymes**
* This causes drug interactions (warfarin, theophylline, etc.)
51
**Contraindicated** population groups for **Fluoroquinolones**?
1. Children
2. Pregnant women
52
Daptomycin
53
Metronidazole
## Footnote
* Anaerobic pathogens
54
Which antibiotic causes a **metallic taste in the mouth** and a **disulfiram-like reaction** to alcohol?
Metronidazole
55
**Rifamycins**
* Rifampin
* Rifabutin
56
Which antibiotic causes **red-orange discoloration** of **body fluids** (harmless)?
**Rifampin**
* Also Rx interactions, hepatotoxicity, and neprhotoxicity
57
Top 3 uses for Rifamycins:
1. **Mycobacterium** (TB, leprosy, avium)
2. **N. meningitidis**
3. **H. flu** type b
58
Why is **Rifabutin** the rifamycin of choice in **HIV patients** or patients taking **warfarin**?
Because **Rifampin** (the other rifamycin) **induces CYP450** enzymes affecting
* warfarin
* theophylline
* **protease inhibitors in HIV**
59
60
Isoniazid
61
Are **side effects** more or less common in **slow acetylators** taking Isoniazid?
Slow acetylators
62
**Isoniazid** - top adverse effects
1. **Vitamin B6** (pyridoxine) **deficiency**
2. Drug interactions (CYP450 inhibition)
3. **Lupus-like reaction** (drug-induced)
4. **Hepatoxicity**
5. **Anion gap metabolic acidosis**
63
Pyrazinamide
64
The risk of this **synergistically** created **adverse effect** is common in patients between treated for active TB with the **RIPE regimen**:
Hepatoxicity
65
Ethambutol
66
**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
**Ethambutol**
* Vision changes are reversible with the discontinuation of this drug
67
Chloroquine
68
P. falciparum (chloroquine-resistant)
Rx combo - **Chloroquine &**
1. Artemisins
2. Atovaquone-proguanil
3. Mefloquine
69
P. vivax & ovale
Chloroquine & Primaquine
* To kill the hypnozoites
