Antibiotics (Final Exam-Spring Semester) Flashcards
For what pathogens would you want to use synergy (two abx together)?
Enterococcus endocarditis or bacteremia
Sepsis
Pseudomonal infections
What is PAE and what drug is an example of this?
Post Antibiotic Effect - organism growth is suppressed for a period of time after drug concentration falls below MIC
Aminogylcosides –> why they are dosed once daily!
What are the two types of antibiotic resistance?
Intrinsic and Acquired
Intrinsic: naturally occuring
Acquired: normally sensitive organism becomes resistant
What is staphylococcus’ resistance pattern and what drugs will not treat it?
They produce beta-lactamase
Don’t use penicillins
Can use penicillinase-resistant PCN
MRSA resistance pattern and what drugs cannot be used to tx?
Alterations in penicillin binding protein
Can’t use any penicillins, cephalosporins, some fluroquinolones
Strep resistance pattern and what drugs cannot be used to tx?
Alterations in binding sites
Penicillins and macrolides
Enterococcus resistance pattern and what drugs cannot be used to tx?
Alterations in target site
Vancomycin
Pseudomonas resistance patterna nd what drugs cannot be used to tx?
Reduced permeability and Beta lactamase production (which is not inhibited by b-lactamase inhibitors)
PCN, cephalosporin, carbepenems, aminoglycosides, fluroquinolones
Advantages of oral administration of abx?
Dec. cost Patient's prefer it Reduce exposure to pathogens via IV site Increases pt motility Potential for early discharge Decreases personnel time
MOA of beta lactams
Bind to penicillin binding proteins and inhibit cell wall synthesis –> cell death
What are the 4 penicillins?
- Natural penicillins
- Aminopenicillins
- Penicillinase Resistant Penicillins
- Extended spectrum penicillins
Cephalexin and Cefazolin are what generation cephalosporins?
1st generation
Cefuroxime and Cefoxitin are what generation cephalosporins?
2nd generation
Cefpodoxime and ceftriaxone are what generation cephalosporins?
3rd generation
Cefepime is what generation cephalosporin?
4th generation
Ceftaroline is what generation cephalosporin?
Newer generation
You are giving penicillins to a patient. What drug interactions must you worry about?
Probenicid
It decreases renal tubular secretion of PCN causing inc. serum levels
What should you warn a patient of when prescribing a 2nd generation penicillin?
GI upset or diarrhea…especially if giving amox/clavulanate
Name the types of antibiotics that work to inhibit penicillin binding protein to inhibit cell wall synthesis and therefore promote cell death
Penicillins
Cephalosporins
Monobactams (Aztreonam)
Carbapenems
If a patient is allergic to PCN (a true allergic reaction) then what antibiotics should be avoided?
Penicillin
Cephalosporins
Carbapenems
You are treating a patient with vancomycin IV. Their labs come back and the culture shows vancomycin resistant enterococci. Would you switch this patient to a different antibiotic? If so, which one?
Daptomycin
What are the two abx that can be used to tx VRSA?
Newer gen. cephalosporin –> ceftaroline (IV)
Daptomycin
Your patient shows symptoms consistent w/ cellulitis. What tx do you initially give?
Penicillinase resistant PCN
- Docloxacillin
- Oxacillin (IV)
- Nafcillin (IV)
A patient comes to the ER with community acquired pneumonia and also states that they stop breathing when given penicillin. What is a good drug choice to treat this patient?
Macrolide…I would use azithromycin
Which abx bind to the 30S ribosomal subunit and therefore inhibit protein synthesis leading to cell death?
Tetracyclines
Aminoglycosides
Which abx bind to the 50S ribosomal subunit and therefore inhibit protein synthesis leading to cell death?
Macrolides
Clindamycin
What is the first line tx for CA-MRSA?
Sulfamethoxazole/Trimethoprom (Bactrim)
What are some options in treating uncomplicated UTIs
Bactrim
Nitrofurantoin
Fluoroquinolone (Cipro, Levo, Oflo, Norf,) …..NOT Moxifloxacin
What are some options in treating complicated UTIs
Bactrim
Fluoroquinolones (Ciprofloxacin, Ofloxacin, Norfloxacin, Levofloxacin)
ED is a 68 year old man who presents to your pharmacy with a prescription for azithromycin for community acquired pneumonia. He tells you that he currently takes lisinopril because “his kidneys were starting to not work as well”. He also takes warfarin for his atrial fibrillation. Is azithromycin an appropriate treatment option in this patient?
Yes, azithromycin is appropriate
However, this pt will need to be closely monitored d/t his warfarin.
Azithromycin doesn’t need to be renally adjusted
Consider adding beta-lactam d/t his renal dysfunction (amoxicillin or amoxicillin-clavulanate)
