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Clinical Pharm > Antimicrobial Review - Schoenwald > Flashcards

Antimicrobial Review - Schoenwald Flashcards

1
Q

What are the 4 class of beta lactams?

A
  • Penicillins
  • Extended spectrum penicillins
  • Cephalosporins
  • Carbapenems
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2
Q

What are examples of natural PCN?

A

Penicillin G or Penicillin VK
Benzathine Penicillin

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3
Q

Whats the formulation of penicillin G?

A

IV or IM

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4
Q

Whats the formulation for penicillin VK?

A

PO

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5
Q

Whats the formulation for Benzathine penicillin?

A

long-acting IM

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6
Q

If a patient has strep throat what is the abx?

A

Penicillin G or Penicillin VK

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7
Q

If a pt has cellulitis, what is the abx?

A

Penicillin G or Penicillin VK

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8
Q

Pt has syphilis, what is the abx you choose?

A

Benzathine Penicillin

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9
Q

What are the two abx under Aminopenicillins?

A

Ampicillin or amoxicillin

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10
Q

Which aminopenicillins is IV?

A

Ampicillin

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11
Q

Which aminopenicillin is PO

A

Amoxicillin

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12
Q

What does aminopenicillin cover?

A

Strep pyogenes
Strep agalactaie
Strep pneumonia
Enterococci
Borrelia burgdorferi
Listeria

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13
Q

Pt comes with Pharyngitis

A

Ampicillin or amoxicillin

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14
Q

Pt comes with sinusitis

A

Ampicillin or amoxicillin

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15
Q

Pt comes with OM

A

Ampicillin or amoxicillin

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16
Q

Pt comes with endocarditis ppx

A

Ampicillin or amoxicillin

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17
Q

Pt with who is younger than 8 y.o for lyme disease

A

Ampicillin or amoxicillin

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18
Q

Which two abx are Anti-Staphylococcal Penicillins?

A
  • Nafcillin
  • Dicloxacilin
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19
Q

whats the formulation of nafcillin?

A

IV

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20
Q

Whats the formulation for Dicloxacillin?

A

PO

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21
Q

What type of infection is Anti-Staphylococcal Penicillins best for?

A

Skin and soft tissue infections with suspected Staph but works against Strep as well

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22
Q

What are the Augmented Aminopenicillins?

A
  • Ampicillin/sulbactim
  • Amoxicillin/clavulanate
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23
Q

What’s the formulation for Ampicillin/sulbactim?

A

IV

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24
Q

Whats the formulation for Amoxicillin/clavulanate?

A

PO

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25
Q

What does augmenting the PCN do?

A

Protects the drug from beta-lactams

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26
Q

What does PCN cover?

A

Same as aminopenicillins plus
- Pasteurella (dog/cat bites)
- Moraxella
- Haemophilus influenza

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27
Q

What are the common augmented PCN treatments?

A
  • Bites
  • Otitis media
  • Sinusitis
  • Acute exacerbation of chronic bronchitis
  • Dental infections
  • Skin and soft tissue infections
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28
Q

What is the augmented extended-spectrum PCN?

A

Piperacillin/tazobactam (Zosyn)

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29
Q

What’s the pip/tazo formulation?

A

IV

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30
Q

Whats the coverage for pip/tazo?

A

Broad spectrum + pseudomonas

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31
Q

Whats the MOA of PCN?

A

Stops cell wall synthesis by binding penicillin binding protein

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32
Q

What is the MOR (Mechanism of resistance) for PCN?

A

Bacteria is developing B lactamases and PBP alterations

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33
Q

What kind of ADR do you see with PCN?

A

Hypersensitivity rxn

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34
Q

What’s the ADR with clavulanate?

A
  • Diarrhea
  • Hepatoxicity
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35
Q

Does gram + coverage increase of decrease with cephalosporin generation?

A

Decreases and gram - increases

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36
Q

How many generation of cephalosporins are there?

A

4 generation and next generation

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37
Q

Which cephalosporins has broad coverage and MRSA?

A

Ceftraoline

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38
Q

Whats the MOA for cephalosporins?

A

Stops cell wall synthesis by binding penicillin binding protein

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39
Q

Whats the MOR for cephalosporins?

A

Beta lactamases

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40
Q

What’s ADR for ceftriaxone?

A

biliary sludging/pseudocholelithiasis

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41
Q

Name 1st fen cephalosporins

A
  • Cefazolin
  • Cephalexin
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42
Q

What the coverage for 1st gen cephalosporins?

A
  • Excellent gram +
  • NO MRSA
  • Low gram - coverage
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43
Q

Bacteria coverage for 1st gen cephalosporins?

A
  • Strep pyogenes, MSSA
  • Some E coli, Klebsiella, Proteus
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44
Q

What are common treatment indication for 1st gen cephalosporins?

A
  • Skin and soft tissue infections
  • Strep pharyngitis
  • Pre op prophylaxis (cefazolin)
  • Uncomplicated cystitis
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45
Q

What are the 2nd generation cephalosporins?

A

Cefuroxime

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46
Q

What does cefuroxime cover?

A

Covers same as 1st generation plus
Strep pneumonia
Moraxella catarrhalis
Haemophilus influenza (respiratory)

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47
Q

when would you use cefuroxime?

A
  • Otitis media
  • Sinusitis
  • Acute exacerbations of chronic bronchitis
  • Skin and soft tissue infections
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48
Q

What are the 3rd generation cephalosporins?

A

Ceftriaxone and cefdinir

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49
Q

What are the coverage for 3rd generation?

A

Gram - and some gram +

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50
Q

T/F Ceftriaxone does not cross the BBB

A

False, it does cross BBB

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51
Q

What are the common indications for 3rd generation?

A
  • Community acquired pneumonia
  • Meningitis
  • Gonorrhea (with Azithromycin)
  • Pyelonephritis
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52
Q

What is the 4th generation cephalosporins?

A

Cefepime

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53
Q

What does cefepime cover?

A
  • Gram - rods
  • More resistant gram negative than pseudomonas
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54
Q

Whats the 5th generation cephalosporins?

A

Ceftraoline

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55
Q

What does ceftaroline cover?

A

Very gram - and gram +
MRSA COVERAGE

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56
Q

Whats are the indication for Ceftraoline?

A
  • Pneumonia
  • Skin and soft tissue infxn
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57
Q

What are the IV formulation for cephalosporins?

A
  • Cefazolin
  • Ceftriaxone (IM too)
  • Cefepime
  • Ceftaroline
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58
Q

What are the different carbapenems?

A
  • Meropenem
  • Imipenem
  • Ertapenem
  • Doripenem
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59
Q

Whats the formulation of carbapenems?

A

IV

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60
Q

Whats the coverage of carbapenems?

A

Excellent gram negative coverage, some gram positive coverage

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61
Q

Whats the MOA for doripenem?

A

Bind to penicillin binding proteins

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62
Q

Whats the MOR for Doripenem?

A

Alteration in PBP protein, efflux pump, and carbapenamase production by bacteria

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63
Q

When is carbapenems used for?

A

More resistant bacteria
- ESBL
- Pseudomonas

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64
Q

What is one carbapenem that doesn’t cover pseudomonas?

A

Ertapenem

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65
Q

Whats the ADR for carbapenems?

A

Seizures and nephrotoxicity

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66
Q

What are the common treatment indications for carbapenems?

A
  • Ventilator associated pneumonia
  • Resistant complicated UTI
  • Nosocomial infections
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67
Q

What are different tetracyclines?

A

Tetracycline, minocycline, doxycycline (PO,IV)

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68
Q

Whats the MOA for tetracycline?

A

protein synthsis inhibition at 30 S bacterial ribosome

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69
Q

MOR for tetracycline?

A

Efflux pump

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70
Q

Is tetracycline bacterocidal or static?

A

Bacteriostatic

71
Q

Whats the ADR for tetracyclines?

A

Photosensitivity
Contraindicated in pregnancy/kids <8 years of age

72
Q

What are the common indications for tetracycline?

A
  • Sinusitis
  • Acute Exacerbations of chronic bronchitis
  • Community acquired pneumonia
  • Non gonococcal urethritis/cervicitis
  • TICK BORNE disease (Lyme, Rickettsia)
73
Q

What other meds should you not add tetracycline with and why?

A

Isotretinoin causes pseudotumor cerebri

74
Q

What supplement should you be careful with when taking tetracycline?

A
  • Calcium bc decreases absorption
  • They can have dietary supplements but have to wait for few hours
75
Q

What are the different macrolide?

A

Azithromycin, clarithromycin and erythromycin

76
Q

What bugs do macrolides cover?

A

Strep pneumo, Strep pyogenes, Moraxella catarrhalis, H influenza, Chlamydia, Mycoplasma, H pylori, and pertussis

77
Q

Whats the MOA of macrolide?

A

protein synthesis inhibition at 50S ribosome

78
Q

Whats the MOR for macrolide?

A

ribosomal changes and efflux pump

79
Q

Whats the pharmacology of macrolides?

A

Bacteriostatic

80
Q

Whats the safety concerns for macrolide?

A
  • Clarithromycin potent CYPA4 inhibiter-monitor warfarin
  • QTC prolongation> azithromycin has new black box warning
81
Q

Which Macrolide causes N/V & Diarrhea

A

Erythromycin

82
Q

What macrolide causes metallic taste?

A

Clarithromycin

83
Q

Common indications for Macrolides

A

Pharyngitis (typically given with another agent bc resistance)
Otitis media
Community acquired pneumonia/atypical pneumonia(Mycoplasma)
Whooping cough-pertussis
Urethritis and cervicitis
H pylori

84
Q

Whats example of lincosamide?

A

Clindamycin

85
Q

What does clindamycin cover?

A

Anaerobes (above diaphragm (dental, lung infection)), Staph aureus and Strep pyogenes in PCN allergic patients

86
Q

Whats the MOA of lincosamides?

A

protein synthesis inhibition at 50 S ribosome

87
Q

Whats the MOR of lincosamides?

A

Ribosomal modification

88
Q

Whats the pharmacology of lincosamides?

A

Bacteriostatic

89
Q

Whats the ADR for lincosamides?

A
  • Diarrhea/Nausea
  • C.diff
90
Q

Whats the common indication treatment for clindamycin?

A
  • Substitute If PCN allergy for soft skin tissue infection and strep pharyngitis
  • Anaerobic infxn/abscess
  • Dental infxn
91
Q

What are the best FQ for non-respiratory?

A

Ciprofloxacin

92
Q

T/F FQ do not cover pseudomonas

A

False, it does and mostly gram - coverage

93
Q

When is FQ treatment indicated for non-respiratory?

A
  • Complicated UTI (pyelonephritis, prostatitis)
  • Enteric infections/traveler’s diarrhea
  • Diverticulitis (plus metronidazole
94
Q

When is FQ treatment indicated for respiratory?

A
  • CAP
  • Pelvic infxn
95
Q

What are the ADRs for FQ

A
  • Arthropathy
  • “Contraindicated” in kids < 18
  • Tendinopathy (acute Achilles tendon rupture)
  • More common in elderly & pts on steroids
  • CNS toxicity
  • Photosensitivity
  • QT prolongation
  • Dysglycemia
  • Neuropathy
96
Q

What are the sulfonamide abx?

A

TMP/SMX aka Bactrim

97
Q

What does TMP/SMX cover

A
  • Gram neg and positive
  • MRSA
  • E coli, Klebsiella, Proteus, MRSA
  • Pneumocystis jiroveci
  • H influenza, Moraxella catarrhalis
98
Q

Whats the MOA for sulfonamides?

A

Inhibition of folate synthesis

99
Q

Whats the MOR for sulfonamides?

A

Alteration in folate synthesis, decreased binding sites

100
Q

Whats the sulfonamides pharmacology?

A
  • Inhibit CYP2C9-INCREASE INR in warfarin therapy
  • Retention of potassium
  • Renal excretion – Renally dose
  • Bacteriostatic
101
Q

Whats the ADR for sulfonamindes?

A
  • Hypersensitivity rxn
  • Myelosuppression
  • Hemolytic anemia in G6PD deficiency
102
Q

Whats the common treatment indications for sulfonamindes?

A
  • PCP pneumonia and prophylaxis
  • UTI – Uncomplicated ones
  • MRSA skin and soft tissue infections
103
Q

What are the two nitroimdazoles?

A

Metronidazole
Tinidazole

104
Q

Which nitroimdazole is IV?

A

Metronidazole

105
Q

What does nitroimdazole cover?

A

anaerobes below the diaphragm, protozoa (giardia etc

106
Q

Whats the MOA for nitroimdazoles?

A

DNA damage

107
Q

Whats the MOR for Nitroimdazole?

A

Unknown

108
Q

Whats the pharmacology for nitroimdazole?

A
  • Hepatic
  • Bacteriocidal
109
Q

What are the ADR for nitroimdazole?

A
  • Metallic taste
  • Disulfram rxn (use w/ alcohol)
  • Facial flushing
  • Tachycardia
  • N/V
  • Diarrhea
  • Fetotoxic in 1st trimester
110
Q

Whats the common indications for nitroimdazoles?

A

Anaerobes
Bacterial vaginosis, C diff (not rlly), giardia and trichomoniasis, abdominopelvic infections ( plus another abx)

111
Q

What are the two aminoglycosides?

A

Gentamicin and Tobramycin

112
Q

What formulation does aminoglycosides come in?

A

Only IV

113
Q

What coverage does aminoglycosides include?

A

Gram negative and pseudomonas

114
Q

What is aminoglycosides mostly for?

A

Nosocomial infection

115
Q

Whats the MOA for aminoglycosides?

A

Inhibit 30 S ribosome

116
Q

MOR for aminoglycosides?

A

Ribosomal modification and efflux mechanisms

117
Q

Whats the pharmacology for aminoglycosides?

A

Renal excretion
Narrow Therapeutic window-measure troughs
bacteriocidal

118
Q

Whats the ADR for aminoglycosides?

A
  • Nephrotoxicity
  • Ototoxicity
119
Q

Whats example of glycopepties?

A

Vancomycin

120
Q

Is vancomycin IV or PO?

A

Both

121
Q

What does vanco cover?

A

C.diff (PO only)
MRSA infxn and gram + (IV only)

122
Q

whats the MOA for vanco?

A

Inhibits cell wall synthesis

123
Q

Whats the MOR for vanco?

A

alterations in binding sites

124
Q

Whats the pharmacology for glycopeptides?

A
  • Renal excretion
  • Trough target 10-20
  • NO ORAL absorption of PO formulation
  • Bacteriocidal gram positive organism only
  • Infuse over 1 hour/slowly to avoid “Red Man Syndrome”
125
Q

Whats the ADR for glycopeptides?

A

Ototoxicity, nephrotoxicity, Red Man Syndrome

126
Q

Whats formulation for Nitrofurantoin?

A

PO only

127
Q

When is nitrofurantoin indicated?

A

Uncomplicated UTI ONLY. Not for kidney infxn

128
Q

What does nitrofurantoin cover?

A

Gram negative and gram positive coverage
Used for ESBL resistance mechanism for UTI

129
Q

Whats ADR for nitrofurantoin?

A

Hemolytic anemia potential in G6PD deficiency

130
Q

Whats the trade name for fosfomycin?

A

Monourol

131
Q

When is it indicated?

A

UTI PO, ESBL + UTI

132
Q

How do you take fosfomycin?

A

Comes in powder packet to be missed with water (3 grams orally x 1 dose)
Generally well tolerated

133
Q

Can you take fosfomycin for kidney infection?

A

NO, only for uncomplicated UTI

134
Q

What are all the antimycobacterials?

A
  • Rifampin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol
135
Q

What’s the ADR for Isoniazid?

A
  • Increased liver enzymes
  • Peripheral neuropathy
136
Q

Whats the first line meds for latent TB?

A

Rifampin

137
Q

What should you avoid rifampin with?

A

Avoid with HIV meds

138
Q

Whats the ADR with rifampin?

A
  • Red Lobster syndrome
  • Elevated liver enzymes can occur
139
Q

Review slide 38

A

-

140
Q

Whats the ADR with pyrazinamide?

A

Polyarthralgia

141
Q

Is Pyrazinamide part of active or latent TB?

A

Part of multidrug regimen for treatment of active TB

142
Q

Whats the ADR for ethambutol?

A

Color blindness

143
Q

Is Ethambutol part of active or latent TB?

A

Active

144
Q

What is amphotericin B used for?

A

Resistant/deep fungal infections

145
Q

Whats the formulation for Nystatin?

A

Topical powder or mouthwash

146
Q

Whats the indication for nystatin?

A

thrush or intertrigo

147
Q

What do you use on the skin for fungal infxn?

A

Clotrimazole
Miconazole

148
Q

What do you use for vaginal fungal infxn?

A

terconazole, miconazole (monistat), tioconazole

149
Q

What do you use for topical oral antifungal?

A

clotrimazole (Mycelex) , miconazole

150
Q

What are the systemic antifungals

A

Ketoconazole
Itraconazole
Fluconazole
Voriconazole
Posaconazole

151
Q

Whats the pharmacology for azoles?

A

Inhibits CYP2C9 (warfarin)
Renal excretion
Qt prolongation

152
Q

When are azoles indicated?

A

Candidal infections-vulvovaginitis, esophagitis

153
Q

What is the only antifungal that gets into the bladder for fungal tx?

A

Fluconazole

154
Q

Whats the formulation for terbinafine?

A
  • PO
  • Topical
155
Q

Whats the ADR for terbinafine?

A

Hepatotoxic

156
Q

Whats the indication for Terbinafine?

A

Used for onychomycosis and cutaneous dermatophyte infections

157
Q

What are the ABX associated with nephrotoxicity?

A

Aminoglycosides>ATN usually gentamicin
Vancomycin

158
Q

Which abx causes red man syndrome?

A

vancomycin

159
Q

What abx causes red lobster syndrome?

A

Rifampin

160
Q

What abx causes discolored teeth?

A

tetracyclines

161
Q

What abx causes yellow babies?

A

Sulfonamides

162
Q

Whats the cat B for preg?

A

Beta lactams
Clindamycin
Azithromycin
Metronidazole-EXCEPT in first trimester maybe fetotoxic

163
Q

Is metronidazole ok in the 1st trimester?

A

No, fetotoxic

164
Q

What is cat C in pregnancy?

A

Fluoroquinolones
Clarithromycin
Tmp/smx

165
Q

Whats Cat D in pregnancy?

A

Aminoglycosides
Tetracyclines

166
Q

Whats the acronym for abx that causes complication in pregnancy?

A

F
A
S
T

167
Q

What is the F in Fast complication?

A

FQ - Arthrhopathy

168
Q

Whats the complication of aminoglycosides?

A

Possible CN8 toxicity in fetus

169
Q

Which abx causes newborn kernicterus?

A

Sulfonamides

170
Q

Which abx causes tooth/bone problems?

A

Tetracycline

171
Q

What is type I hypersensitivity rxns?

A

IgE mediated>anaphylaxis/urticaria

172
Q

What is type II hypersensitivity rxns?

A

IgG and complement mediated>bone marrow suppression

173
Q

What is type III hypersensitivity rxns?

A

Antibody /antigen complexes>serum sickness/post streptococcal glomerulonephritis

174
Q

What is type IV hypersensitivity rxns?

A

T cell>delayed hypersensitivity rxn>stevens Johnson/toxic epidermal necrolysis/organ rejection

Clinical Pharm (8 decks)

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