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IC Part II > Antibiotics I & II Review > Flashcards

Antibiotics I & II Review Flashcards

1
Q
  • fungal overgrowth
  • most common type of superinfection
  • continue administration of antibacterial agent
  • treat w/ antifungal , ex: oral nystatin for GI
A

intestinal candidiasis

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2
Q
  • life threatening
  • discontinue admin of antibacterial agent
  • treat w/ oral vancomycin (not absorbed, treats locally)
A

staphylococcal enterocolitis

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3
Q
  • life threatening, caused by c/ difficile
  • discontinue admin of antibacterial
  • treat w/ oral metronidazole (or vancomycin)
  • often caused by clindamycin
A

pseudomembranous colitis

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4
Q

-aminoglycosides, vancomycin, minocycline cause what organ directed toxicity?

A

ototoxicity

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5
Q

chloramphenicol and sulfonamides cause what organ directed toxicity?

A

hematopoietic

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6
Q

tetracyclines, macrolides, isoniazid, sulfonamides, and ampho B cause what organ directed toxicity?

A

hepatotoxicity

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7
Q

aminoglycosides, vancomycin, ampho B, cephalosporins, and sulfonamides cause what organ directed toxicity?

A

renal

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8
Q

primaquine, sulfonamides, and nitrofurantoin cause what idiosyncratic response?

A

hemolytic anemia (in G6PDH deficiency)

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9
Q

tetracyclines, sulfonamides, and fluoroquinolones cause what idiosyncratic response?

A

photosensitivity

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10
Q

sulfonamides can cause what hypersensitivity reaction?

A

stevens johnson

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11
Q

beta lactams and vanocmycin blocks enzymatic steps in the _______ space, and other ICWs (fosfomycin, cycloserine) act at _______ sites

A

periplasmic

intracellular

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12
Q

penicillins primarily useful against gram positive microbes?

A

pen G, pen V

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13
Q

nafcillin, methcillin, oxacillin, dicloxacillin are __________ penicillincs

A

anti-staph

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14
Q

ampicillin, amoxacillin, piperacillin, ticarcillin are extended spectrum penicillins with increased ________ activity

A

gram negative

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15
Q

antipseudomonal penicillins effective against proteus and pseudomonas? use in combo with aminoglycoside

A

piperacillin, ticarcillin

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16
Q

beta lactam drugs that inhibit cell wall synthesis but are less susceptible to penicillinases, bactericidal

A

cephalosporins

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17
Q

cefazolin and cephalexin are ____ generation cephalosporins

A

1st

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18
Q
  • good activity against gram positive and modest gram negative
  • treat staph and strep cellulitis
  • DOC for surgical prophylaxis
A

cefazolin (1st gen)

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19
Q

cefaclor, cefoxitin, cefuroxime, cefotetan are _____ generation cephs

A

2nd (fur ox with two fac tets)

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20
Q
  • increased activity against gram negative bacteria (Ecoli, Kelbsiella, Proteus, haemophilus, moraxella catarrhalis)
  • PID, diverticulitis, surgical prophylaxis for abdominal, bronchitis
A

uses for 2nd gen cephalosporins (cefaclor, cefoxitin, cefuroxime, cefotetan)

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21
Q

-ceftriaxone, cefotaxime, ceftazidime, cefpodoxime are ______ generation cephs

A

3rd

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22
Q
  • decreased gram (+) but increased gram negative (enterobacter, serratia)
  • pseudomonas activity
  • meningitis
  • CAP, lyme disease, osteomyelitis, gonorrhea
  • penetrate CNS, so many useful in meningitis
A

3rd gen cephalosporin use

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23
Q

cefipime a ____ generation cephalosporin

A

4th

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24
Q
  • extensive gram positive and gram neg activity
  • increased resistance to beta lactamases
  • reserve for situations such as neutropenic fever
A

4th gen ceph (cefepime)

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25
Q
  • MRSA activity, gram negs except pseduomonas

- approved for cSSSIs and CAP

A

5th gen cephalosporin (ceftaroline)

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26
Q
  • monobactam, only gram negative activity
  • no anaerobe activity
  • for pseudomonas use w/ an aminoglycoside
  • beta lactamase resistant
  • no cross reactivity to penicillin allergies
A

aztreonam

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27
Q
  • broad spectrum: gram (+), (=), and anaerobes
  • beta lactamase resistant
  • inactivated by renal dipeptidase (co admin cilastatin)
  • cross sensitivity w/ penicillin allergies
  • pseduomonas resistance rapid, so use w/ aminoglycosides
A

carbapenems: imipenem, meropenem, doripenem, ertapenem

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28
Q

vancomycin inhibits _________ by binding to D-ala D-ala terminus of petidoglycan monomer

A

transglycosylation

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29
Q

vancomycin bactericidal for _______ bacteria

A

gram positive

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30
Q

vancomycin used systemically for ______

A

MRSA

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31
Q

vancomycin enhances oto and nephro toxicity of ________

A

aminoglycosides

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32
Q
  • used for infections caused by gram positive, penicillin resistant organisms
  • s. aureus, MRSSA, enterococci, C diff alternative treatment
A

vancomycin

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33
Q
  • newer ICWS, gram positive and negative activity
  • inhibits cytoplasmic step in cell wall precursor synthesis
  • actively transported by G6P transporter into bacteria
  • approved for single dose therapy of UTI
  • actively excreted by kidney
A

fosfomycin

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34
Q
  • topical antibiotic only, for gram (+) organisms

- markedly nephrotoxic

A

bacitracin

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35
Q

-inhibit dihydrofolate synthesis, bacteriostatic (-cidal when combined with trimethoprim)

A

sulfonamides (sulfamethoxazole, sulfadizaine)

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36
Q
  • inhibits dihydrofolate reductase, bacteriostatic

- combo for UTIs, shigella, salmonella, pneumocystis, toxoplasmosis

A

trimethoprim, pyrimethamine (protozoa), methotrexate (mammalian)

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37
Q

-inhibit prokaryotic enzymes topoisomerase II, bactericidal

A

fluoroquinolones

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38
Q
  • prototype quinolone

- oral, rapidly glucoronidated and actively excreted in urine

A

nalidixic acid

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39
Q

all fluoroquinolones have what suffix?

A

-floxacin

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40
Q
  • actively excreted in urine, blocked by probenicid

- treat gram (-) rods of urinary and GI tracts, some gram (+), otitis externa

A

fluoroquinolones

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41
Q

-excellent activity against many gram (-) bacteria (gonococcus, psuudomonas, mycobacteria, chlamydia)

A

2nd gen fluoroquinolones (cipro, ofloxacin)

42
Q
  • 3rd gen fluoroquinolone, given 2X daily

- greater gram (+) activity (strp pneumo, enterococci, MRSA), resp infections)

A

levofloxacin

43
Q

-broadest spectrum fluoroquinolones, respiratory

A

4th gen (moxifloxacin, gemifloxacin)

44
Q
  • chronic infections with long dormant periods separating intermittent active periods
  • intracellular pathogens
  • requires constant prolonged treatment with multiple drugs
A

tuberculosis and leprosy

45
Q

_______ favored over rifampin for HIV patients on HAART cocktails b/c of less DDIs

46
Q
  • may involve oxidative stress, urinary tract antiseptic
  • excreted in urine 50% as active drug
  • treats UTI, gram positive or negative, most effective at acidic urine pH
  • adverse: headaches, anorexia, GI, hemolytic anemia if G6PDH deficient
  • pseudomonas and proteus resistant
A

nitrofurantoin

47
Q
  • alter permeability and damage bacterial cytoplasmic membrane, leakage
  • gram (-) only
  • topically
  • systemically as last resort for pseudomonas
  • nephrotoxic
A

polymixins (colistin, polymixin E, polymixin B)

48
Q
  • binds cell membrane of susceptible organisms, causes rapid depolarization
  • gram (+) only
  • IV
  • treats complicated skin infections
  • used for vancomycin resistant bacteria
A

daptomycin

49
Q
  • binds bacterial isoleucyl transferase RNA synthetase, inhibits protein synthesis
  • topical: for impetigo caused by s aureus and s. pyogenes
  • intranasal for MRSA
50
Q

abx of choice for:

H pylori

A

amoxicillin, clarithromycin, omerprazole

51
Q

abx of choice for: listeria

A

ampicillin

52
Q

abx of choice for: neisseria gonorrhea

A

ceftriaxone, cefexime

53
Q

abx of choice for: H. influenza, klebsiella

A

3rd gen cephalosporins

54
Q

abx of choice for: borrelia burgdorferi, Rickettsiae?

A

doxycycline

55
Q

abx of choice for: legionella

A

erythromycin

56
Q

abx of choice for: candida

A

fluconazole, miconazole, nystatin

57
Q

abx of choice for: mycobacterium tuberculosis

A

isoniazid, rifampin, ethambutol, pyrazinamide

58
Q

abx of choice for: mycoplasma pneumonia, legionella, corynebacterium diptheria, chlamydia

A

macrolides

59
Q

abx of choice for: trichomonas, c diff

A

metronidazole

60
Q

abx of choice for: treponema pallidum, bacillus anthracis, clostridium, bacteroides

A

penicillin G

61
Q

abx of choice for: campylobacter, shigella

A

fluoroquinolones

62
Q

abx of choice for: vibrio cholera

A

tetracycline

63
Q

abx of choice for: salmonella, shigella

64
Q

abx of choice for: C diff

A

metronidazole, vancomycin

65
Q

prophylaxis for surgical procedures?

66
Q

prophylaxis for surgery where anaerobe present?

A

cefoxitin, cefotetan

67
Q

prophylaxis for GBS?

A

ampicillin, penicillin

68
Q

prophylaxis for pneumocytsis, UTIs?

69
Q

prophylaxis for h influenza, meningococcal infxn?

70
Q

prophylaxis for malaria?

A

chloroquine

71
Q

prophylaxis for M. avium in AIDS?

A

azithromycin

72
Q

prophylaxis for dental procedures?

A

amoxicillin, azithromycin, clindamycin

73
Q

-aminoglycosides, tetracyclines, tigecycline and spectinomycin target the ______ ribosomal subunit

74
Q

chloramphenicol, macrolides, tilethromycin, linezolid, and quinupristin-dalfopristin target the _______ ribosomal subunit

75
Q

________ irreversibly inhibit the 30S subunit, making them bactericidal

A

aminoglycosides

76
Q
  • reversible binding to 30S subunit
  • bacterostatic
  • chelate metal ions, not absorbed so don’t admin with food/milk/antacids
  • concentrates in teeth, bone, liver, bile, kidney
  • cross placenta and excreted in milk
A

tetracyclines

77
Q
  • mycoplasma, chlamydia, rickettsiae, H pylori
  • prophylaxis for plasmodiium falciparum
  • helpful for lyme disease
  • ability to accumulate intracellulary
A

tetracyclines

78
Q
  • tetracycline analog
  • used for CAP, skin and suture infections, intra abdominal infxn (MRSA, E. faecalis)
  • FDA black box warning for mortality
A

tigecycline

79
Q
  • cause superinfections
  • impaired liver functions
  • photosensitization
  • calcium chelation
A

adverse effects of tetracyclines

80
Q
  • impaired influx/increased efflux by active transport protein pump
  • overuse has fostered emergence of resistance
A

tetracyclines

81
Q
  • reversible inhibitor of protein synthesis (50S subunit) , bacteriostatic
  • CNS levels = serum levels
  • glucoronidation in liver is rate limiting step for clearance
A

chloramphenicol

82
Q
  • adverse:
  • anemia due to bone marrow depression, usually reversible
  • aplastic anemia: irreversible and fatal
  • gray baby syndrome: newborns are poor glucoronidators
  • DDIs, inhibits enzymes
A

chloramphenicol

83
Q
  • powerful antibacterial limited by toxicity
  • typhoid fever, RMSF
  • alternate for bacterial meningitis, topical for eye infexns
A

chloramphenicol

84
Q
  • bacteriostatic or -cidal depending on dose
  • 50S IPS
  • acid labile - use enteric coat or ester
  • CNS, crosses placenta
  • excreted in bile, half life 2-5 hours except one drug
A

macrolides (erythryomycin, clarithromycin, azithromycin)

85
Q
  • GI distress
  • cholestatic jaundice
  • microsomal enzyme inhibition
  • used for atypical pneumonia (mycoplasma, legionnaire’s, chlamydia), back for penicillin sensitive patients
A

macrolides

86
Q

-plasmid mediated resistance to staph, strep, pneumococci

A

macrolides

87
Q

newer macrolide with less GI effects, given with ethambutal for m avium

A

clarithromycin

88
Q

-macrolide with minimal P450 inteactions, tissue levels 100X plasma levels (half life 2-4 days), active against m. avium, shorter dosing period

A

azithromycin

89
Q
  • ketolide
  • treatment of CAP
  • may prolong QT interval
  • hepatic failure, respiratory failure in myasthenia gravis
  • DDIs CYP3A4
A

telithromycin

90
Q
  • lincosamide
  • 50S IPS
  • good for bacteroides fragilis
  • with primaquine treats pneumocystis in AIDS
  • with pyrimethamine for toxoplasmosis
  • adverse: clostridium superinfections, hepatotoxicity
A

clindamycin

91
Q
  • significant CYP3A4 inhibitor
  • complete cross resistance b/w two components
  • no cross resistance with other IPS
  • bacteriostatic against E faecium, cidal against others
  • e. faecalis is resistant
  • approved for vanco and MDR e. facium and MRSA
A

streptogramins (quinupristin, dalfopristin)

92
Q
  • binds 23S rRNA of 50S subunit
  • no cross resistance with other IPS
  • IV or oral
  • for vanco resistant e faecium, MRSA
  • adverse: bone marrow suppression, inhibits MAO
  • serotonin syndrome
93
Q

gentamicin, streptomycin, tobramycin, amikacin, neomycin (topical)

A

aminoglycosides

94
Q
  • bactericidal, inactivate 30S subunit irreversibly

- interfere w/ initiation, misread mRNA, break up polysomes

A

aminoglycosides

95
Q
  • IV, no significant host metabolism
  • glomerular filtration, high concentrations in proximal tubules
  • rapid resistance alone
  • anaerobes resistant (oxygen dependent uptake)
A

aminoglycosides

96
Q
  • once daily dosing, removes factor of time maintaining concentration
  • nephrotoxic: exacerbated in vanco, cephs, ampho B, cisplatin and other nephrotoxics
  • ototoxicity
  • neuromuscular blockade in MG, common during surgery
A

aminoglycosides

97
Q
  • use for infections with aerobic gram negatives
  • ecoli, proteus, klebsiella, serratia, enterobacter
  • cell wall inhibitors are synergistic
  • treats pseduomonas in combo with penicillins
  • tuberculosis
A

aminoglycoside uses

98
Q
  • postantibiotic effect
  • useful for non resistant gram (-) infections
  • use older first
A

aminoglycosides

99
Q

order of use of aminoglycosides for pseudomonas?

A

gentamycin > tobramycin > amikacin

100
Q
  • related to aminoglycosides and tetracyclines (30S IPS)

- useful against drug resistant gonococci and patients allergic to cephalosporins

A

spectinomycin

IC Part II (29 decks)

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