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Pharm I > Antibiotics - bacterial > Flashcards

Antibiotics - bacterial Flashcards

1
Q

4 types of antimicrobials?

A

bacterial
fungal
viral
other: mycobacterium, parasites

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2
Q

two ways to classify antibiotics by scope?

A

narrow spectrum: relatively small # of specific organisms will be sensitive to that agent (ex. penicillin)
broad spectrum: broad range of organisms will be sensitive to that agent (ex. piperacillin/tazobactam)

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3
Q

5 MOAs for antibiotics?

A
  1. inhibition of cell wall synthesis (penicillin, bacitracin, cephalosporin, vancomycin)
  2. disruption of cell membrane function (polymyxin)
  3. inhibition of protein synthesis (tetracycline, erythromycin, streptomycin, chloramphenicol)
  4. inhibition of nuclei acid synthesis (rifamycin, quinolones, metronidazole)
  5. action as antimetabolites (sulfonilamide, trimethoprim)
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4
Q

two ways to categorize abx by their killing capabilities?

A

bacteriostatic: keep at the # that is there
bactericidal: kill the bacteria off

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5
Q

two ways to categorize antimicrobials by pharmacodynamic profiles?

A

time dependent

concentration dependent

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6
Q

different categories of bugs?

A

gram (+): streptococci, staphylococci, enterococci
gram (=): enterobacteriaceae, pseudomonas
anaerobes: bacteroides fragilis

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7
Q

general bacterial classifications?

A

aerobe vs anaerobe

gram (+) vs gram (=)

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8
Q

shapes of bac?

A

cocci or rods

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9
Q

important aerobic gram (+) cocci?

A

staphylococci: s. aureus, coag-negative staph
streptococci: s. pneumoniae, group B strep, viridans strep
enterococci: e. faecalis, e. faecium

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10
Q

important aerobic gram (=)?

A

gram (=) rods: e. coli, k. pneumoniae, serratia, enterobacter, h. influenze, p. aeruginose
gram (=) cocci: m. catarrhalis, m. gonorrhoeae, n. meningitidis

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11
Q

important atypical respiratory aerobes? what makes them atypical?

A

legionella spp, mycoplasma pneumonia, chlamydia pneumoniae

lack a cell wall, intracellular organisms & can’t be seen w/gram staining process

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12
Q

where do true anaerobes generally live?

A

the gut!
bacteroides fragilis
clostridium difficile (causes diarrhea)

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13
Q

two oral anaerobes?

A

prevotella

peptostreptococcus

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14
Q

what is sensitivity in relation to abx?

A

the degree to which microbial organisms are killed or their proliferation is arrested by the drug

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15
Q

4 factors that determine sensitivity of microbes?

A
  1. reach microorganism
  2. bind to or enter the microorganism
  3. interfere w/vital microbial fxn
  4. remain chemically intact while acting upon the microorganism
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16
Q

how to test a bugs sensitivity to a drug?

A

done in vitro
dilution tests: minimum inhibitory concentration; minimum bactericidal concentration
disk-diffusion technique

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17
Q

7 ways to categorize abx via chemical structure?

A
  1. sulfonamides
  2. penicillins
  3. cephalosporins
  4. macrolides
  5. tetracyclines
  6. quinolones
  7. others
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18
Q

what is the main structure that inhibits cell wall synthesis?

A

beta-lactam ring structure

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19
Q

MOA of penicillin? two ways for bugs to have resistance?

A

MOA: B-lactam inhibits cell wall synthesis by binding to penicillin binding proteins
resistance via B-lactamases & altered PBPs

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20
Q

is penicillin time or dose dependent? bacteriostatic or bacteriocidal?

A

time dependent

bacteriocidal

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21
Q

4 different types of penicillins and penicillin congeners?

A

natural penicillin (penicillin G and penicillin VK)
aminopenicillins (amoxicillin, ampicillin)
penicillinase-resistance penicillins (methicillin, where we hear about MRSA)
extended spectrum PCNs + beta-lactamase inhibitor (piperacillin, tazobactram)

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22
Q

effective uses of penicillin? bioavailability? spectrum of use? given how?

A

often resistant b/c bacterial have evolved so only a few we can treat w/penicillin: gram (+) streptococci, oral anaerobes
drug of choice for N. meningitidis, syphilis
poor bioavailability, narrow spectrum of use
give per IV

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23
Q

penicillinase-resistant penicillin use?

A

naficillin
major drug used for MSSA
can be used to tx gram (+) strep and MSSA and oral anaerobes

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24
Q

two examples of aminopenicillins? aminopenicillins MOA? used to tx what?

A

ampicillin, amoxicillin
MOA: binds to PBPs and inhibits synthesis of cell wall
used to tx respiratory infxn (not as common anymore),, sinusitis, otitis, lower respiratory tract infxns, endocarditis from enterococcus
can be used to tx gram (+) strep and enterococci; some gram (=)s, oral anaerobes

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25
Q

ex of extended-spectrum penicillins?

spectrum? bugs it can treat? how to use?

A

piperacillin
broad spectrum, severe infections
gram (+) strep, staph, possibly eneterococci
gram (=)- excellent- pseudomonas aeruginosa
given in combo w/B-lactamase inhibitor so it can act on those bugs which produce the B-lactamase

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26
Q

MOA of B-lactamase inhibitors?

A

increase treatment capacity against MSSA and enterobactieraceae and anaerobes

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27
Q

bugs pencillin/B-lactamase inhibitor can be used on?

A

gram (+) strep, MSSA, maybe enterococci
gram (=) P. aeurginosa
all anaerobes

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28
Q

possible adverse rxns with penicillins?

A

allergic reaction: anaphylaxis, rash, urticaria, fever
5-20% report allergy, <20% who think they have an allergy actually have an allergy
diarrhea

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29
Q

type I allergic reaction? common to see in what type of abx?

A

IgE
occur w/in 1 hr of dose
urticarial rash, pruritis, flushing, angioedema of face or laryngeal tissues, wheezing, hypotension
anaphylaxis
common to see w/B-lactam drugs; ~5% cross reactivity w/cephalosporins if true allergy

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30
Q

4 less common adverse penicillin rxns?

A

hematologic: anemia, thrombocytopenia
hepatitis w/nafcillin/oxacillin
interstitial nephritis: nafcillin/oxacillin
seizures: high doses, renal failure

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31
Q

SEs of amoxicillin and clavulanate/augmentin?

A

notable increased SEs from clavulanic acid, clavulanate alone has very little antimicrobial activity but causes copious GI distress and diarrhea

32
Q

what is the most severe cause of abx induced diarrhea?

A

pseudomembranous colitis (c. difficile colitis)

33
Q

most of the abx are cleared in which way?

A

most are cleared renally

34
Q

what is the only major interaction w/amoxicillin?

A

acacia

35
Q

MOA of cephalosporins?

A

binds to beta-lactam ring of cell wall and inhibits organisms ability to form new cell walls

36
Q

between 1st, 2nd, 3rd and 4th generation cephalosporins, which have the greatest activity against gram (+)s, against gram (=)s?

A

1st and 2nd have greatest activity against gram (+)s

3rd and 4th have greatest activity against gram (=)s

37
Q

what bug do cephalosporins NEVER cover??

A

enterococcus

38
Q

1st generation cephalosporins use? what bugs does it cover?

A

indications: UTIS, skin infxns, some respiratory and prophylaxis surgically
used against gram (+) strep, MSSA; gram (=) e. coli, klebsiella; oral anaerobes
can be used as an alternative to penicillin allergic pts

39
Q

2nd generation cephalosporins use? what bugs does it cover?

A

indicated in some respiration and GI infections
gram (+) strep, MSSA
gram (=)- good coverage overall
oral anaerobes + b. fragilis

40
Q

3rd generation cephalosporin use? bugs it covers?

A 
use: respiratory infxns, serious infxns
gram (+) strep, MSSA
gram (=): very good, p. aeruginosa
oral anaerobes
some are able to cross BBB
41
Q

4th generation cephalosporin use? what bugs?

A

serious hospital infxns
gram (+) strep and MSSA
gram (=): excellent, p. aeruginosa
oral anaerobes only

42
Q

what can 5th generation cephalosporins cover?

A

MRSA
strep pneumonia
covers GNR, but not pseudomonas

43
Q

exceptions of cephalosporins that are not cleared renally?

A

ceftriaxone so don’t need to adjust for reduced renal fxn

44
Q

ADRs of cephalosporins?

A

allergic rxns: anaphylaxis, rash, urticaria, fever, 3-7% cross resistance with penicillin allergy
diarrhea
less common: anemia, thrombocytopenia, seizures when given at high doses

45
Q

two other beta-lactam drugs? MOA? what can provide bugs w/resistance?

A

monobactams and carbapenems
MOA: inhibit cell wall synthesis
resistance via B-lactamases, outer membrane protein mutations
very broad spectrum, sever infxns in hospital

46
Q

macrolides use? bugs it covers?

A

erythromycin, azithromycin
good coverage of respiratory infections, chlamydia, syphilis, gonorrhea, sinusitis, bronchitis, COPD
gram (+) strep, MSSA, pneumococci
gram (=) minimal w/h. flu
oral anaerobes
useful in treating atypical respiratory pathogens such as legionella, chlamydia, mycoplasma

47
Q

ADRs of macrolides?

A

GI: n/v, diarrhea b/c cause direct (+) motility of gut; erythro is worse than clarithro which is worse than azithro
phlebitis with IV erythro
less common: prolonged QT interval
hepatotoxicity

48
Q

what enzyme do macrolides inhibit?

A

CYP450-3A4

49
Q

4 major interactions with azithromycin?

A

all possibly prolong the QT segment

cesium, ephedra, oleander, sida cordifolia

50
Q

MOA of tetracyclines?

A

inhibit protein synthesis by binding to the 30s ribosomal subunit (inhibits translation)
bacteriostatic

51
Q

what can tetracyclines be used to tx?

A

increased resistance limits their use
respiratory, intracellular infxns, acne and rosacea, chlamydia, SSTI
gram (+) strep, MSSA
gram (=) h. flu, rickettsiae, other gram (=)s often resistance
oral anaerobes
atypical respiratory pathogens such as legionella, clamydia pneumonia, mycoplasma pneumonia

52
Q

ADRs of tetracyclines?

A 
photosensitivity
nausea
diarrhea
tooth discoloration in children (C/I in children less than 8 and PG)
less common: esophagitis, leukocytosis
53
Q

what can tetracyclines not be given with? can be used in what populations?

A

do not give with Ca2+ supplements as it causes chelation of calcium ions
can be used in those who are PNC allergic
can be used in renal failure

54
Q

MOA of sulfonamids?

A

inhibits folic acid synthesis via enzyme inhibition

bacteriostatic

55
Q

can combine sulfamethoxazoe w/what other abx? what will this combo cover? what can this combo be used to tx?

A

can be combined with trimethoprim/bactrim
variable wide activity when used in combo
gram (+) strep, MSSA, CAMRSA
gram (+) most enterobacteriaceae
oral anaerobes
indications: UTI, otitis media, sinusitis, bronchitis, pneumocystitis prophylaxis, community acquired MRSA, SSTI
there is however increasing resistance

56
Q

ADRs of bactrim? what drug does it specifically act with to increase its effects?

A

allergic rxns, rash, fever, photosensitivity, urticaria, GI effects, neutropenia, thrombocytopenia (folate deficiency)
rare: Steven Johnsons Syndrome (severe rash)
increases effects of warfarin!

57
Q

MOA of fluroroquinolones? resistance mechanisms?

A

MOA: inhibits bacterial DNA gyrase, inhibiting DNA replication and transcription, bactericidal
resistance: mutations at target sites, efflux pumps

58
Q

bugs fluoroquinolones can act against?

A

potent broad-spectrum agent, most gram (=): p. aerugonisa

atypical pathogens: community acquired pneumonia- legionella, clamydia pneu, mycoplasma pneu

59
Q

indications for fluoroquinolones? problems?

A

UTI, pyleo, upper and lower respiratory tract infxns, SSTI, joint infxns
increasing resistance
increase evidence of adverse rxns

60
Q

ADRs of fluoroquinolones?

A

GI: nausea
CNS: h/a, dizziness, insomnia
less common: cartilage toxicity, AVOID use in children and PG, CNS: confusion, seizures; prolonged cardiac QT interval

61
Q

interactions w/fluoroquinolones? need to be taken away from what items?

A

any drug that can prolong the QT interval
like the macrolides
cesium, ephedra, grapefruit, sidea cordifolia, sweet orange
need to take away from calcium, iron, antacids, enteral feeding

62
Q

MOA of anti-anaerobes (metronidazole and clindamycin)? resistance how?

A

metronidazole: inhibits nucleic acid synthesis
clindamycin: ribosomal protein synthesis inhibitor
resistance: rare w/metron, mutations in ribosomes w/clinda

63
Q

use metronidazole against what?

A

only anaerobes!
indications: vaginitis, h.pylori in PUD, c. difficle, associated diarrhea, intra-abdominal abscess, lung abscess, peritonitis

64
Q

use clindamycin against what?

A

gram (+) and anaerobes
NO GRAM (=)s
indications: SSTI, anaerobic infxns, topical available for acne vulgaris, bacterial vaginosis

65
Q

ADRs of metronidazole?

A

nausea, diarrhea, metallic taste

drug interaction: disulfiram rxn: flushing, sweating, nausea w/EtOH, can persist a few days after

66
Q

ADRs of clindamycin?

A

diarrhea, nausea, c. difficile

67
Q

indication of nitrofurantoin/macrobid? MOA?

A

indication: lower UTIs but NOT for pyelonephritis, considered safe before 38 wks gestation
MOA: disrupts both DNA and RNA of bacteria which are sensitive to the drug

68
Q

SEs of nitrofurantoin/macrobid?

A

n/v, diarrhea
less common: fever, chills, pulmonary fibrosis
not recommended for pyelonephritis and not effective in significant renal impairment

69
Q

additional abx classes for hospital severe infxns? MOA? what bugs can they be used against?

A

aminoglycosides
MOA: bactercidial, inhibit protein synthesis
can be used against gram (=0 such as pseudomonas auerginosa

70
Q

6 abx that can be used effectively to treat MRSA?

A 
IV vancomycin
daptomycin
telavancin
ceftaroline
tigecycline
linezolid
71
Q

3 abx to use for community acquired MRSA (CAMRSA)

A

clindamycin
tetracycline
bactrim

72
Q

6 drugs that cover pseudomonas?

A 
aminoglycosides
ciprofloxacin, levofloxacin
ceftazidime, defepime, ceftolozane/tazobactam
piperacillin, ticarcillin
aztreonam
imimpenem, meropenem, doripenem
73
Q

what abx provide true anaerobic coverage?

A 
metronidazole
B-lactam/B-lactamase inhibitors
carbapenems
moxifloxacin
clindamycin
cefoxitin/cefotetan
74
Q

topical abx?

A

mupirocin/bactroban
bacitracin
polysporin OTC (combo of bacitracin and polymyxin)
neosporin OTC (combo of bacitracin along with neomycin and polymyxin B

75
Q

probiotic strains which have been proven to prevent c. difficile?

A

lactobacillus combos or single agent regiments

Pharm I (18 decks)

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