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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
classes of beta lactams
Penicillin Cephalosporins Carbapenems Monobactam (aztreonam)
26
beta lactam MOA
bactericidal by targeting the cell wall .time dependent killing (freq over dose) potentially bactericidal
27
beta lactam adverse reactions
rash drug fever thrombocytopenia seizure
28
C/I | Penicillins:
previous allergic rx or anaphylaxis to other beta-lactam classes
29
C/I | Aminopenicillins + B-lactamase inhibitors:
empiric intra-abdominal infections due to increasing Bacteriodes resistance
30
C/I | Cephalosporin (3rd gen) Cefazidime:
empiric coverage of gram NEGATIVE infections (increasing resistance) severe MSSA coverage (bacteremia/endocarditis) 1st gen ceph better!
31
Carbapenems C/i
lower the sz threshold Avoid in head trauma or sz history.
32
Monobactams c/i
overall costly, assoc. with phlebitis and increased LFTS... try to not use if really needed
33
penicillin to know (3) drug list/DOC
o Pencillin G IV o PenVK PO o Benzathine penicillin IM DOC: beta-hemolytic Strep, syphilis
34
Anti-staphylococcal PCN (3) drug list/DOC
o Nafcillin o Oxacillin o Dicloxacillin DOC: MSSA infections
35
aminopenicillins (2) DOC
o Ampicillin o Amoxicillin DOC (ampicillin): Enterococcus
36
extended spectrum penicillin
Piperacillin-tazobactam (Zosyn) PIP-TZO
37
Aminopenicillins plus Beta-lactamase Inhibitors types (2)
o Ampicillin-sulbactam (Unasyn) | o Amoxicillin-clavulaunate (Augmentin)
38
adverse reaction to cephalosporins
fever rash seizure biliary sludge
39
species that cephalosporins do not cover
enterococcus | anaerobes
40
first gen cephalosporin list (2)
``` o Cefazolin (Ancef) o Cephalexin (Keflex) ```
41
first gen cephalosporins spectrum
MSSA | Strep
42
mc use of first gen cephalosporins
surgical prophylaxis | non purulent skin infection
43
2nd gen cephalosporin list (3)
* Cefoxitin [Mefoxitin]    * Cefuroxime [Ceftin] * Cefaclor [Ceclor]
44
2nd gen cephalosporins spectrum
* Same as 1st generation (MSSA, strep species and some GN) | * Improved GN activity
45
2nd gen cephalosporins use
* Surgical prophylaxis if they cover anaerobes | * URI
46
3rd gen cephalosporin list (1)
• Ceftriaxone [Rocephin]
47
3rd gen cephalosporin use
o Empiric UTI, CAP, URTI Empiric and targeted meningitis (ceftriaxone)
48
4th gen cephalosporin list
o Cefepime (Maxipime)
49
4th gen cephalosporin use
good gram positive and negative coverage INCLUDING pseudomonas doesn't work on: MRSA, ESBL, enterococcus, anaerobes
50
only cephalosporin that covers MRSA (class and name)
5th generation o Ceftaroline (Teflaro)
51
carbapenems (list) (3)
``` o Ertapenem (Invanz) o Imipenem/cilastatin (Primaxin) o Meropenem (Merrem) ```
52
carbapenems ADRs
seizures (esp imipenem) fever rash
53
carbapenems spectrum
broadest of all Abx classes GN, GP, ESBL, anaerobes
54
monobactam drug type
o Aztreonam
55
spectrum of monobactam
only gram negative includes pseudomonas
56
List the commonly used fluoroquinolones (3)
* Ciprofloxacin (Cipro) * Levafloxacin (Levaquin) * Moxifloxacin (Avelox)
57
fluoroquinolones MOA
bactericidal CANNOT be used with staph aureus, enterococcus (except with UTI) even if sensitive
58
levofloxin spectrum
fluoroquinolone CAP, complicated UTI, pyelonephritis, prostatitis
59
moxifloxin spectrum
fluoroquinolone intra-abdominal infections, CAP
60
cipro spectrum
complicated UTI, pyelonephritis and prostatitis-.
61
can fluroquinalones be used in an uncomplicated UTI?
DON"T DO IT increased risk of C.diff colitis.  
62
ADRS of fluoroquinalones (8)
* confusion, * hallucinations * HA * dizziness * tendon rupture (BBW) * QT prolongation * C.diff colitis * potentiate warfarin  
63
commonly used macrolides
* Erythromycin * Azithromycin (Zithromax) * Clarithromycin (Biaxin)
64
macrolide MOA
• bacteriostatic
65
macrolide anti-microbial uses (4)
o atypical CAP o chlamydia o urethritis o MAC  
66
ADE: associated with macrolides (3)
* QT prolongation, * increased LFT, * potentiates warfarin [erythro and clarithro only]
67
List the commonly used aminoglycosides (2)
* Gentamycin | * Tobramycin
68
aminoglycosides MOA
Bactericidal - concentration dependent killing has post-antibiotic effect - even when the drug is gone the bacteria is still stunned
69
aminoglycosides indications
enterococcal endocarditis noscicomial infections
70
aminoglycosides toxicity
nephrotoxicity, ototoxicity peak and trough levels
71
commonly used tetracyclines (3)
``` o Minocycline (Minocin) o Doxycycline (Adoxa, Vibramycin) o Tetracycline ```
72
Tetracyclines MOA
Binds to 30S ribosome and inhibits protein synthesis. Bacteriostatic
73
Tetracyclines use (4)
MRSA/cellulitis COPD exacerbations CAP Acne
74
when are Tetracyclines NOT used
UTI
75
adverse Tetracyclines reactions
rash photosensitivity teeth staining
76
Tetracyclines CI
children <8 pregnancy breastfeeding
77
vancomycin MOA
weakly bactericidal and time depending killing-stay above MIC monitor with trough levels
78
vancomycin specturm
staph (including MRSA), strep, enterococcus oral: C. Diff
79
DOC for MSSA
beta lactam
80
ADR vancomycin (prevention)
o Red man syndrome (lengthen infusion) o Rash o Nephrotoxicity (adjust dose based on trough)
81
Bactrim MOA
bacteriostatic
82
Bactrim antimicrobial activity
some gram negatives gram positives including MRSA
83
Bactrim use | 3
uncomplicated UTI purulent cellulitis PCP prophylaxis
84
Bactrim ADR (5)
rash fever hyperkalemia Steven- Johnson syndrome potentiates warfarin
85
clindamycin MOA
bacteriostatic
86
clindamycin use (3)
anaerobic infection above the diaphragm cellulitis MRSA infx
87
metronidazole MOA
bactericidal
88
metronidazole MOA
bactericidal
89
metronidazole spectrum DOC
anaerobes and protozoans C.Diff
90
metronidazole ADRs
o metallic taste o neuropathy o disulfuram reaction w/ EtOH o potentiates warfarin
91
nitrofurantoin antimicrobial activity
some gram negatives
92
nitrofurantoin infections
uncomplicated UTI
93
moa rifampipn
bactericidal
94
rifampin use
other antibiotics for synergy in prosthetic joint or surgical hardware infection Tuberculosis
95
ADRs to rifampin
multiple drug-drug interactions elevated LFTs
96
linezolid infections
MRSA | VRE infections
97
linezolid precautions
SSRIs (serotonin syndrome) myelosuppression
98
daptomycin infections
MRSA | VRE infections
99
daptomycin precautions
can't use for lung infections or muscle damage

FA17 Infectious Disease (9 decks)

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