Antimicrobial Review (Schoenwald) (Midterm) Flashcards
“Beta lactams” contain which classes of abx?
- Penicillins
- Extended spectrum penicillins
- Cephalosporins
- Carbapenems
Penicillin G may be given (choose 1 or more answers):
a) PO
b) IV
c) IM
B and C (IV or IM)
Penicillin VK may be given (choose 1 or more answers):
a) PO
b) IV
c) IM
a) PO
What is the preferred abx for syphilis and how is it administered?
Benzathine penicillin IM
Which abx are in the “natural penicillins” class?
- Penicillin G
- Penicillin VK
- Benzathine Penicillin
Which abx are in the “aminopenicillin” class? What do these abx commonly treat?
- Ampicillin
- Amoxicillin
- Common tx:
- Pharyngitis
- Sinusitis
- Otitis media
- Endocarditis prophylaxis
- Lyme dz (age <8 y/o)
Which abx are in the “anti-staphylococcal penicillin” class? What do these abx commonly tx?
- Nafcillin
- Dicloxacillin
- Common tx:
- Skin and soft tissue infxn w/ suspected Staph but works great against Strep as well
Ampicillin may be given (choose 1 or more answer):
a) PO
b) IV
c) IM
b) IV
*It’s the IV equivalent of amoxicillin
Amoxicillin may be given (choose 1 or more answers):
a) PO
b) IV
c) IM
a) PO
Nafcillin may be given (choose 1 or more answers):
a) PO
b) IV
c) IM
b) IV
Dicloxacillin may be given (choose 1 or more answers):
a) PO
b) IV
c) IM
a) PO
Which abx are included in the “augmented aminopenicillin” class? What are these abx commonly used to tx?
- Ampicillin/sulbactam (Unasyn)
- Amoxicillin/clavulanate (Augmentin)
- Common tx:
- Bites (dogmentin, duh)
- Otitis media
- Sinusitis
- Acute exacerbation of chronic bronchitis
- Dental infxns
- Skin and soft tissue infxns
Ampicillin/sulbactam (Unasyn) may be given (choose 1 or more answers):
a) PO
b) IV
c) IM
b) IV
Amoxicillin/clavulanate (Augmentin) may be given (choose 1 or more answers):
a) PO
b) IV
c) IM
a) PO
Which abx are included in the “augmented extended-spectrum penicillins” class? What are these abx commonly used to tx?
- Piperacillin/tazobactam (Zosyn)
- Common tx:
- Broad spectrum with Pseudomonas coverage
- Think hospitalized pts
What is the MOA of penicillins?
Stops cell wall synthesis by binding penicillin binding protein.
What is the MOR of Penicillins?
Beta lactamases and penicillin binding protein (PBP) alterations
Penicillins are bacteriostatic or bacteriocidal?
Bacteriocidal
Clavulanate can be associated with what adverse drug rxn?
Diarrhea and subclinical hepatotoxicity
In general, 1st generation cephalosporins have excellent gram (+ or -) activity and poor gram (+ or -) activity.
Excellent gram +
Poor gram -
Cephalosporins: Gram positive activity (increases/decreases) as generations increase.
Decreases
Cephalosporins: Gram negative activity (increases/decreases) as generations increase.
Increases
MOA of cephalosporins?
Stops cell wall synthesis by binding penicillin binding protein
MOR of cephalosporins?
Beta lactamases
What is a possible adverse drug reaction of cephalosporins?
Ceftriaxone linked with biliary sludging/pseudocholelithiasis
Which abx are 1st gen cephalosporins?
- Cefazolin (Ancef)
- Cephalexin (Keflex)
Cefazolin (Ancef) may be given (choose 1 or more answers):
a) PO
b) IV
c) IM
b) IV
Cephalexin (Keflex) may be given (choose 1 or more answers):
a) PO
b) IV
c) IM
a) PO
What are some examples of bacteria and conditions you can treat with 1st gen cephalosporins?
- Coverage: gram-positives excellent EXCEPT MRSA
- Strep pyogenes
- MSSA
- Some E coli, klebsiella, proteus
- Common tx indications:
- Skin and soft tissue infections
- Strep pharyngitis
- Pre-op prophylaxis (cefazolin)
- Uncomplicated cystitis
What’s the one 2nd gen cephalosporin Schoeny wants us to know? How is it given (PO/IV/IM)?
Cefuroximine (Ceftin) PO
2nd gen cephalosporins are good at covering what bugs?
Same as 1st gen, plus Strep pneumo, M cat, and H flu (respiratory)
Which abx are included in 3rd gen cephalosporin class?
- Ceftriaxone (Rocephin)
- Cefdinir (Omnicef)
Ceftriaxone (Rocephin) may be given (choose 1 or more answers):
a) PO
b) IV
c) IM
b and c) IV or IM
Cefdinir (Omnicef) may be given (choose 1 or more answers):
a) PO
b) IV
c) IM
a) PO
T/F: Ceftriaxone crosses the blood brain barrier
True
T/F: 3rd gen cephalosporins have good MRSA coverage
False. Only next gen cephalosporins have MRSA coverage.
Common tx indications for 3rd gen cephalosporins?
- Coverage: gram negative with some gram positive
- Common tx indications:
- CAP
- Meningitis
- Gonorrhea
- Pyelonephritis
Which abx is 4th gen cephalosporin?
Cefipime (Maxipime)
Cefepime (Maxipime) may be given (choose 1 or more answers):
a) PO
b) IV
c) IM
b) IV
4th gen cephalosporins can be used for coverage of….
Most gram negative rods, more resistant gram negatives
Which cephalosporin generation is the only generation to have any pseudomonas coverage?
4th gen (cefepime)
Which abx is next (5th) gen cephalosporin?
Ceftaroline (Teflaro)
Ceftaroline (Teflaro) may be given (choose 1 or more answers):
a) PO
b) IV
c) IM
b) IV
Which generation of cephalosporins is the only gen to have MRSA coverage?
Next/5th generation
Which 3 abx are classified as tetracyclines?
- Tetracycline
- Minocycline
- Doxycycline
Tetracyclines may be given (choose 1 or more answers):
a) PO
b) IV
c) IM
a and b) PO or IV
T/F: Tetracyclines cover MRSA
True
MOA of tetracyclines?
Protein synthesis inhibition at 30S bacterial ribosome
MOR of tetracyclines?
Efflux pump
Tetracyclines are bacteriostatic or bacteriocidal?
Bacteriostatic
Examples of adverse drug reactions with tetracyclines?
- Photosensitivity
- Contraindicated in pregnancy or kids <8 y/o
Which meds should you not combine with tetracyclines? Why?
- DO NOT combine with isotretinoin → pseudotumor cerebri
- Calcium decreases absorption
Tick borne disease (lyme, rickettsia) should be tx with which abx?
Tetracyclines
Name the 3 macrolides
- Azithromycin
- Clarithromycin
- Erythromycin
Macrolides may be given (choose 1 or more answers):
a) PO
b) IV
c) IM
a and b) PO or IV
Which abx do you use to tx chlamydia?
- 100 mg Doxycycline BID x7 days (preferred)
- May use Azithromycin as an alternative (i.e. pregnancy)
Abx of choice for pertussis?
Macrolides (Azithromycin or clarithromycin)
MOA of macrolides?
Protein synthesis inhibition at 50S ribosome
MOR of macrolides?
Ribosomal changes and efflux pump
Macrolides are bacteriostatic or bacteriocidal?
Bacteriostatic
Clarithromycin is a potent CYP3A4 inhibitor, which means you need to closely monitor/adjust which of the other patient’s medication?
Warfarin
What should you look out for on EKG with macrolides?
QTc prolongation. Azithromycin has new black box warning.
Adverse drug rxn of macrolides?
- Erythromycin is a promotility agent → n/v/d
- Clarithromycin = metallic taste
Which abx is included in the lincosamide class?
Clindamycin
Clindamycin may be given (choose 1 or more answers):
a) PO
b) IV
c) IM
a and b) PO or IV
If someone has a serious B-lactam/PCN allergy, you can use _______________ instead for skin and soft tissue infections and strep pharyngitis.
Clindamycin
Clindamycin is good for (Anaerobic or aerobic) infections above the diaphragm.
Anaerobic
MOA of clindamycin?
Protein synthesis inhibition at 50S ribosome
MOR of clindamycin?
Ribosomal modification
Clindamycin is bacteriostatic or bacteriocidal?
Bacteriostatic
ADR of clindamycin?
- Nausea
- Diarrhea
- C diff
T/F: Fluoroquinolones do not cover pseudomonas
False
Which fluoroquinolones are respiratory vs non-respiratory?
- Respiratory: Levofloxacin and Moxifloxacin
- Non-respiratory: Ciprofloxacin
MOA of fluoroquinolones?
Inhibit bacterial DNA topoisomerase
MOR of fluoroquinolones?
Alteration in DNA topoisomerase
Fluoroquinolones are bacteriostatic or bacteriocidal?
Bacteriocidal
____ and ____ decrease absorption of fluoroquinolones
Ca and Mg
What EKG change should you look out for when someone is taking a fluoroquinolone?
QTc prolongation
What are common non-respiratory indications for fluoroquinolones?
- Complicated UTI (pyelonephritis, prostatitis)
- Enteric infections/traveler’s diarrhea
- Diverticulitis (plus metronidazole)
- Pelvic infections
What is a common respiratory indications for fluoroquinolones?
CAP
ADRs associated with fluoroquinolones?
- Arthropathy (“contraindicated” in kids <18)
- Tendinopathy (Achilles rupture)
- CNS toxicity
- Photosensitivity
- QT prolongation
- Dysglycemia
- Neuropathy
Which abx is/are in the Sulfonamides class and are they given PO/IV/IM?
Trimethoprim/sulfamethoxazole (Bactrim or Septra)
- PO or IV
MOA of sulfonamides?
Inhibition of folate synthesis
MOR of sulfonamides?
Alteration in folate synthesis, decreased binding sites
Which bugs do suolfonamides cover?
- Gram negative and positive
- MRSA
- E coli, klebsiella, proteus
- Pneumocystis jiroveci
- H flu, M cat
Sulfonamides can increase the effects of what other medication?
Sulfonamides inhibit CYP2C9, which can lead to an increased INR in warfarin therapy
Which lab value on BMP should you watch out for with sulfonamides?
Hyperkalemia
T/F: Sulfonamides are cleared via the liver
False. Kidneys.
Sulfonamides are bacteriocidal or bacteriostatic?
Bacteriostatic
ADRs of sulfonamides?
- Hypersensitivity rxn
- Myelosuppression
- Hemolytic anemia in G6PD deficiency
Common tx indications for sulfonamides?
- PCP PNA (ayyyy jiroveci *Italian accent*) and prophylaxis
- UTI
- MRSA skin and soft tissue infections
Which abx are in the nitromidazole class and how are they given (PO/IV/IM)?
- Metronidazole (Flagyl)
- PO or IV
- Tinidazole (Tindamax)
- PO
MOA of nitromidazoles?
DNA damage