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FA17 Infectious Disease > Antibiotics pharm > Flashcards

Antibiotics pharm Flashcards

1
Q

prophylactic Abx use

A

used in prevention of a bacterial infection BEFORE exposure

mc use is surgical

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2
Q

suppressive abx use

A

used in chronic therapy of infections that can’t be eradicated

i.e. prevention of herpes

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3
Q

therapeutic/definitive/targeted abx use

A

treating a specific organism with a specific Abx

narrow spectrum bc know what its is

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4
Q

empiric abx use

A

coverage of most likely pathogen

general idea, but use broad spectrum

move down to targeted when known

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5
Q

when does prophylactic dosing occur before surgery?

A

usually at the time of incision

re-dose for longer procedures (more than four hours)

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6
Q

MIC

A

lowest concentration of a drug that prevents visible growth

minimum inhibitory concentration

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7
Q

bacteriostatic

A

inhibition of bacterial growth

depends on the host immune system to clear the bacteria

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8
Q

bactericidal

A

directly destroys the bacteria

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9
Q

when would one choose a bactericidal?

A

directly destroys bacteria

preferred for serious infections (febrile neutropenia, meningitis, etc)

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10
Q

what must be considered when choosing an antibiotic regimen

A
  1. consider the infection (site, organism, severity)
  2. consider patient (allergies, age, renal)
  3. don’t be redundant
  4. be cost effective
  5. be convenient
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11
Q

optimal culturing of diabetic foot infections

A

surgical samples

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12
Q

sputum can contaminate a culture, so we do this instead

A

bronchoscopy

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13
Q

when are urine cultures best taken?

A

mid stream, using a fresh catheter

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14
Q

what effect do antibiotics have on culture yield

A

they reduce them significantly

try to get a culture before administration of abx

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15
Q

When shouldn’t you hold off on administering antibiotics

A

if patient is septic or unstable

if you suspect serious condition (pneumonia, febrile neutropenia, etc) then don’t hold back

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16
Q

what agents cover anaerobes? (6)

A
  1. ampicillin-sulbactam
  2. pip-tazo
  3. carbapenems
  4. clindamycin
  5. metronidazole
  6. moxifloxacin
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17
Q

what type of infections require empiric anaerobe coverage? (6)

A
  1. intra-abdominal
  2. DM foot ulcers
  3. gas gangrene
  4. aspiration pneumonia
  5. dental infection
  6. PID
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18
Q

Pseudomonas coverage (6)

A
  1. Pip-tazo
  2. ceftazidime
  3. cefepime
  4. Cipro
  5. Levaquin
  6. carbapenems
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19
Q

What agents cover MRSA? (5)

A
  1. clindamycin
  2. Bactrim
  3. doxycycline
  4. linezolid
  5. vancomycin
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20
Q

Enterococcus coverage:

just learn it sara.

A
  1. PCN
  2. Augmentin
  3. Pip-tazo
  4. ampicillin-sulbactam
  5. vancomycin
  6. daptomycin
  7. linezolid
  8. Ciproflozacin
  9. levofloxacin
  10. nitrofurantoin (UTI)
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21
Q

what type of infections require MRSA coverage? (4)

A

purulent cellulitis

post op wound infection

nosocomial pneumonia

nosocomial meningitis

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22
Q

What types of infections require enterococcus coverage? (3)

A

Intra abdominal infections
UTI
CLABSI

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23
Q

time dependent antibiotics

A

● Drug levels must remain above the organism MIC for a percentage of time during the dosing interval

● Effectiveness improved by frequency, not the dose

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24
Q

concentration dependent antibiotics

A

The higher the dose, the better the efficacy

Balance between efficacy and toxicity - dose as high as possible for best efforts without causing harm

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25
Q

classes of beta lactams

A

Penicillin
Cephalosporins
Carbapenems
Monobactam (aztreonam)

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26
Q

beta lactam MOA

A

bactericidal by targeting the cell wall .time dependent killing (freq over dose)

potentially bactericidal

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27
Q

beta lactam adverse reactions

A

rash
drug fever
thrombocytopenia
seizure

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28
Q

C/I

Penicillins:

A

previous allergic rx or anaphylaxis to other beta-lactam classes

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29
Q

C/I

Aminopenicillins + B-lactamase inhibitors:

A

empiric intra-abdominal infections due to increasing Bacteriodes resistance

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30
Q

C/I

Cephalosporin (3rd gen) Cefazidime:

A

empiric coverage of gram NEGATIVE infections (increasing resistance)

severe MSSA coverage (bacteremia/endocarditis) 1st gen ceph better!

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31
Q

Carbapenems C/i

A

lower the sz threshold

Avoid in head trauma or sz history.

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32
Q

Monobactams c/i

A

overall costly, assoc. with phlebitis and increased LFTS… try to not use if really needed

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33
Q

penicillin to know (3) drug list/DOC

A

o Pencillin G IV
o PenVK PO
o Benzathine penicillin IM

DOC: beta-hemolytic Strep, syphilis

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34
Q

Anti-staphylococcal PCN (3) drug list/DOC

A

o Nafcillin
o Oxacillin
o Dicloxacillin

DOC: MSSA infections

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35
Q

aminopenicillins (2)

DOC

A

o Ampicillin
o Amoxicillin

DOC (ampicillin): Enterococcus

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36
Q

extended spectrum penicillin

A

Piperacillin-tazobactam (Zosyn)

PIP-TZO

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37
Q

Aminopenicillins plus Beta-lactamase Inhibitors types (2)

A

o Ampicillin-sulbactam (Unasyn)

o Amoxicillin-clavulaunate (Augmentin)

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38
Q

adverse reaction to cephalosporins

A

fever
rash
seizure
biliary sludge

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39
Q

species that cephalosporins do not cover

A

enterococcus

anaerobes

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40
Q

first gen cephalosporin list (2)

A 
o	Cefazolin (Ancef)
o	Cephalexin (Keflex)
41
Q

first gen cephalosporins spectrum

A

MSSA

Strep

42
Q

mc use of first gen cephalosporins

A

surgical prophylaxis

non purulent skin infection

43
Q

2nd gen cephalosporin list (3)

A
  • Cefoxitin [Mefoxitin]
  • Cefuroxime [Ceftin]
  • Cefaclor [Ceclor]
44
Q

2nd gen cephalosporins spectrum

A
  • Same as 1st generation (MSSA, strep species and some GN)

* Improved GN activity

45
Q

2nd gen cephalosporins use

A
  • Surgical prophylaxis if they cover anaerobes

* URI

46
Q

3rd gen cephalosporin list (1)

A

• Ceftriaxone [Rocephin]

47
Q

3rd gen cephalosporin use

A

o Empiric UTI, CAP, URTI

Empiric and targeted meningitis (ceftriaxone)

48
Q

4th gen cephalosporin list

A

o Cefepime (Maxipime)

49
Q

4th gen cephalosporin use

A

good gram positive and negative coverage

INCLUDING pseudomonas

doesn’t work on: MRSA, ESBL, enterococcus, anaerobes

50
Q

only cephalosporin that covers MRSA (class and name)

A

5th generation

o Ceftaroline (Teflaro)

51
Q

carbapenems (list) (3)

A 
o	Ertapenem (Invanz)
o	Imipenem/cilastatin (Primaxin)
o	Meropenem (Merrem)
52
Q

carbapenems ADRs

A

seizures (esp imipenem)

fever

rash

53
Q

carbapenems spectrum

A

broadest of all Abx classes

GN, GP, ESBL, anaerobes

54
Q

monobactam drug type

A

o Aztreonam

55
Q

spectrum of monobactam

A

only gram negative

includes pseudomonas

56
Q

List the commonly used fluoroquinolones (3)

A
  • Ciprofloxacin (Cipro)
  • Levafloxacin (Levaquin)
  • Moxifloxacin (Avelox)
57
Q

fluoroquinolones MOA

A

bactericidal

CANNOT be used with staph aureus, enterococcus (except with UTI) even if sensitive

58
Q

levofloxin spectrum

A

fluoroquinolone

CAP, complicated UTI, pyelonephritis, prostatitis

59
Q

moxifloxin spectrum

A

fluoroquinolone

intra-abdominal infections, CAP

60
Q

cipro spectrum

A

complicated UTI, pyelonephritis and prostatitis-.

61
Q

can fluroquinalones be used in an uncomplicated UTI?

A

DON”T DO IT

increased risk of C.diff colitis.

62
Q

ADRS of fluoroquinalones (8)

A
  • confusion,
  • hallucinations
  • HA
  • dizziness
  • tendon rupture (BBW)
  • QT prolongation
  • C.diff colitis
  • potentiate warfarin
63
Q

commonly used macrolides

A
  • Erythromycin
  • Azithromycin (Zithromax)
  • Clarithromycin (Biaxin)
64
Q

macrolide MOA

A

• bacteriostatic

65
Q

macrolide anti-microbial uses (4)

A

o atypical CAP
o chlamydia
o urethritis
o MAC

66
Q

ADE: associated with macrolides (3)

A
  • QT prolongation,
  • increased LFT,
  • potentiates warfarin [erythro and clarithro only]
67
Q

List the commonly used aminoglycosides (2)

A
  • Gentamycin

* Tobramycin

68
Q

aminoglycosides MOA

A

Bactericidal - concentration dependent killing

has post-antibiotic effect - even when the drug is gone the bacteria is still stunned

69
Q

aminoglycosides indications

A

enterococcal endocarditis

noscicomial infections

70
Q

aminoglycosides toxicity

A

nephrotoxicity, ototoxicity

peak and trough levels

71
Q

commonly used tetracyclines (3)

A 
o	Minocycline (Minocin)
o	Doxycycline (Adoxa, Vibramycin)
o	Tetracycline
72
Q

Tetracyclines MOA

A

Binds to 30S ribosome and inhibits protein synthesis.

Bacteriostatic

73
Q

Tetracyclines use (4)

A

MRSA/cellulitis
COPD exacerbations
CAP
Acne

74
Q

when are Tetracyclines NOT used

A

UTI

75
Q

adverse Tetracyclines reactions

A

rash
photosensitivity
teeth staining

76
Q

Tetracyclines CI

A

children <8
pregnancy
breastfeeding

77
Q

vancomycin MOA

A

weakly bactericidal and time depending killing-stay above MIC

monitor with trough levels

78
Q

vancomycin specturm

A

staph (including MRSA), strep, enterococcus

oral: C. Diff

79
Q

DOC for MSSA

A

beta lactam

80
Q

ADR vancomycin (prevention)

A

o Red man syndrome (lengthen infusion)

o Rash

o Nephrotoxicity (adjust dose based on trough)

81
Q

Bactrim MOA

A

bacteriostatic

82
Q

Bactrim antimicrobial activity

A

some gram negatives

gram positives including MRSA

83
Q

Bactrim use

3

A

uncomplicated UTI
purulent cellulitis
PCP prophylaxis

84
Q

Bactrim ADR (5)

A

rash

fever

hyperkalemia

Steven- Johnson syndrome

potentiates warfarin

85
Q

clindamycin MOA

A

bacteriostatic

86
Q

clindamycin use (3)

A

anaerobic infection above the diaphragm

cellulitis

MRSA infx

87
Q

metronidazole MOA

A

bactericidal

88
Q

metronidazole MOA

A

bactericidal

89
Q

metronidazole spectrum

DOC

A

anaerobes and protozoans

C.Diff

90
Q

metronidazole ADRs

A

o metallic taste

o neuropathy

o disulfuram reaction w/ EtOH

o potentiates warfarin

91
Q

nitrofurantoin antimicrobial activity

A

some gram negatives

92
Q

nitrofurantoin infections

A

uncomplicated UTI

93
Q

moa rifampipn

A

bactericidal

94
Q

rifampin use

A

other antibiotics for synergy in prosthetic joint or surgical hardware infection

Tuberculosis

95
Q

ADRs to rifampin

A

multiple drug-drug interactions

elevated LFTs

96
Q

linezolid infections

A

MRSA

VRE infections

97
Q

linezolid precautions

A

SSRIs (serotonin syndrome)

myelosuppression

98
Q

daptomycin infections

A

MRSA

VRE infections

99
Q

daptomycin precautions

A

can’t use for lung infections or muscle damage

FA17 Infectious Disease (9 decks)

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