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RRCCPA Pharmacotherapeutics > Antimicrobial Review (Schoenwald) (Midterm) > Flashcards

Antimicrobial Review (Schoenwald) (Midterm) Flashcards

1
Q

“Beta lactams” contain which classes of abx?

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

Penicillin G may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

B and C (IV or IM)

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3
Q

Penicillin VK may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

a) PO

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4
Q

What is the preferred abx for syphilis and how is it administered?

A

Benzathine penicillin IM

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5
Q

Which abx are in the “natural penicillins” class?

A
  • Penicillin G
  • Penicillin VK
  • Benzathine Penicillin
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6
Q

Which abx are in the “aminopenicillin” class? What do these abx commonly treat?

A
  • Ampicillin
  • Amoxicillin
  • Common tx:
    • Pharyngitis
    • Sinusitis
    • Otitis media
    • Endocarditis prophylaxis
    • Lyme dz (age <8 y/o)
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7
Q

Which abx are in the “anti-staphylococcal penicillin” class? What do these abx commonly tx?

A
  • Nafcillin
  • Dicloxacillin
  • Common tx:
    • Skin and soft tissue infxn w/ suspected Staph but works great against Strep as well
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8
Q

Ampicillin may be given (choose 1 or more answer):

a) PO
b) IV
c) IM

A

b) IV

*It’s the IV equivalent of amoxicillin

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9
Q

Amoxicillin may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

a) PO

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10
Q

Nafcillin may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

b) IV

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11
Q

Dicloxacillin may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

a) PO

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12
Q

Which abx are included in the “augmented aminopenicillin” class? What are these abx commonly used to tx?

A
  • 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
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13
Q

Ampicillin/sulbactam (Unasyn) may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

b) IV

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14
Q

Amoxicillin/clavulanate (Augmentin) may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

a) PO

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15
Q

Which abx are included in the “augmented extended-spectrum penicillins” class? What are these abx commonly used to tx?

A
  • Piperacillin/tazobactam (Zosyn)
  • Common tx:
    • Broad spectrum with Pseudomonas coverage
    • Think hospitalized pts
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16
Q

What is the MOA of penicillins?

A

Stops cell wall synthesis by binding penicillin binding protein.

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17
Q

What is the MOR of Penicillins?

A

Beta lactamases and penicillin binding protein (PBP) alterations

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18
Q

Penicillins are bacteriostatic or bacteriocidal?

A

Bacteriocidal

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19
Q

Clavulanate can be associated with what adverse drug rxn?

A

Diarrhea and subclinical hepatotoxicity

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20
Q

In general, 1st generation cephalosporins have excellent gram (+ or -) activity and poor gram (+ or -) activity.

A

Excellent gram +

Poor gram -

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21
Q

Cephalosporins: Gram positive activity (increases/decreases) as generations increase.

A

Decreases

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22
Q

Cephalosporins: Gram negative activity (increases/decreases) as generations increase.

A

Increases

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23
Q

MOA of cephalosporins?

A

Stops cell wall synthesis by binding penicillin binding protein

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24
Q

MOR of cephalosporins?

A

Beta lactamases

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25
Q

What is a possible adverse drug reaction of cephalosporins?

A

Ceftriaxone linked with biliary sludging/pseudocholelithiasis

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26
Q

Which abx are 1st gen cephalosporins?

A
  • Cefazolin (Ancef)
  • Cephalexin (Keflex)
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27
Q

Cefazolin (Ancef) may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

b) IV

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28
Q

Cephalexin (Keflex) may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

a) PO

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29
Q

What are some examples of bacteria and conditions you can treat with 1st gen cephalosporins?

A
  • 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
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30
Q

What’s the one 2nd gen cephalosporin Schoeny wants us to know? How is it given (PO/IV/IM)?

A

Cefuroximine (Ceftin) PO

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31
Q

2nd gen cephalosporins are good at covering what bugs?

A

Same as 1st gen, plus Strep pneumo, M cat, and H flu (respiratory)

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32
Q

Which abx are included in 3rd gen cephalosporin class?

A
  • Ceftriaxone (Rocephin)
  • Cefdinir (Omnicef)
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33
Q

Ceftriaxone (Rocephin) may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

b and c) IV or IM

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34
Q

Cefdinir (Omnicef) may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

a) PO

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35
Q

T/F: Ceftriaxone crosses the blood brain barrier

A

True

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36
Q

T/F: 3rd gen cephalosporins have good MRSA coverage

A

False. Only next gen cephalosporins have MRSA coverage.

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37
Q

Common tx indications for 3rd gen cephalosporins?

A
  • Coverage: gram negative with some gram positive
  • Common tx indications:
    • CAP
    • Meningitis
    • Gonorrhea
    • Pyelonephritis
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38
Q

Which abx is 4th gen cephalosporin?

A

Cefipime (Maxipime)

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39
Q

Cefepime (Maxipime) may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

b) IV

40
Q

4th gen cephalosporins can be used for coverage of….

A

Most gram negative rods, more resistant gram negatives

41
Q

Which cephalosporin generation is the only generation to have any pseudomonas coverage?

A

4th gen (cefepime)

42
Q

Which abx is next (5th) gen cephalosporin?

A

Ceftaroline (Teflaro)

43
Q

Ceftaroline (Teflaro) may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

b) IV

44
Q

Which generation of cephalosporins is the only gen to have MRSA coverage?

A

Next/5th generation

45
Q

Which 3 abx are classified as tetracyclines?

A
  • Tetracycline
  • Minocycline
  • Doxycycline
46
Q

Tetracyclines may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

a and b) PO or IV

47
Q

T/F: Tetracyclines cover MRSA

A

True

48
Q

MOA of tetracyclines?

A

Protein synthesis inhibition at 30S bacterial ribosome

49
Q

MOR of tetracyclines?

A

Efflux pump

50
Q

Tetracyclines are bacteriostatic or bacteriocidal?

A

Bacteriostatic

51
Q

Examples of adverse drug reactions with tetracyclines?

A
  • Photosensitivity
  • Contraindicated in pregnancy or kids <8 y/o
52
Q

Which meds should you not combine with tetracyclines? Why?

A
  • DO NOT combine with isotretinoin → pseudotumor cerebri
  • Calcium decreases absorption
53
Q

Tick borne disease (lyme, rickettsia) should be tx with which abx?

A

Tetracyclines

54
Q

Name the 3 macrolides

A
  • Azithromycin
  • Clarithromycin
  • Erythromycin
55
Q

Macrolides may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

a and b) PO or IV

56
Q

Which abx do you use to tx chlamydia?

A
  • 100 mg Doxycycline BID x7 days (preferred)
  • May use Azithromycin as an alternative (i.e. pregnancy)
57
Q

Abx of choice for pertussis?

A

Macrolides (Azithromycin or clarithromycin)

58
Q

MOA of macrolides?

A

Protein synthesis inhibition at 50S ribosome

59
Q

MOR of macrolides?

A

Ribosomal changes and efflux pump

60
Q

Macrolides are bacteriostatic or bacteriocidal?

A

Bacteriostatic

61
Q

Clarithromycin is a potent CYP3A4 inhibitor, which means you need to closely monitor/adjust which of the other patient’s medication?

A

Warfarin

62
Q

What should you look out for on EKG with macrolides?

A

QTc prolongation. Azithromycin has new black box warning.

63
Q

Adverse drug rxn of macrolides?

A
  • Erythromycin is a promotility agent → n/v/d
  • Clarithromycin = metallic taste
64
Q

Which abx is included in the lincosamide class?

A

Clindamycin

65
Q

Clindamycin may be given (choose 1 or more answers):

a) PO
b) IV
c) IM

A

a and b) PO or IV

66
Q

If someone has a serious B-lactam/PCN allergy, you can use _______________ instead for skin and soft tissue infections and strep pharyngitis.

A

Clindamycin

67
Q

Clindamycin is good for (Anaerobic or aerobic) infections above the diaphragm.

A

Anaerobic

68
Q

MOA of clindamycin?

A

Protein synthesis inhibition at 50S ribosome

69
Q

MOR of clindamycin?

A

Ribosomal modification

70
Q

Clindamycin is bacteriostatic or bacteriocidal?

A

Bacteriostatic

71
Q

ADR of clindamycin?

A
  • Nausea
  • Diarrhea
  • C diff
72
Q

T/F: Fluoroquinolones do not cover pseudomonas

A

False

73
Q

Which fluoroquinolones are respiratory vs non-respiratory?

A
  • Respiratory: Levofloxacin and Moxifloxacin
  • Non-respiratory: Ciprofloxacin
74
Q

MOA of fluoroquinolones?

A

Inhibit bacterial DNA topoisomerase

75
Q

MOR of fluoroquinolones?

A

Alteration in DNA topoisomerase

76
Q

Fluoroquinolones are bacteriostatic or bacteriocidal?

A

Bacteriocidal

77
Q

____ and ____ decrease absorption of fluoroquinolones

A

Ca and Mg

78
Q

What EKG change should you look out for when someone is taking a fluoroquinolone?

A

QTc prolongation

79
Q

What are common non-respiratory indications for fluoroquinolones?

A
  • Complicated UTI (pyelonephritis, prostatitis)
  • Enteric infections/traveler’s diarrhea
  • Diverticulitis (plus metronidazole)
  • Pelvic infections
80
Q

What is a common respiratory indications for fluoroquinolones?

A

CAP

81
Q

ADRs associated with fluoroquinolones?

A
  • Arthropathy (“contraindicated” in kids <18)
  • Tendinopathy (Achilles rupture)
  • CNS toxicity
  • Photosensitivity
  • QT prolongation
  • Dysglycemia
  • Neuropathy
82
Q

Which abx is/are in the Sulfonamides class and are they given PO/IV/IM?

A

Trimethoprim/sulfamethoxazole (Bactrim or Septra)

  • PO or IV
83
Q

MOA of sulfonamides?

A

Inhibition of folate synthesis

84
Q

MOR of sulfonamides?

A

Alteration in folate synthesis, decreased binding sites

85
Q

Which bugs do suolfonamides cover?

A
  • Gram negative and positive
  • MRSA
  • E coli, klebsiella, proteus
  • Pneumocystis jiroveci
  • H flu, M cat
86
Q

Sulfonamides can increase the effects of what other medication?

A

Sulfonamides inhibit CYP2C9, which can lead to an increased INR in warfarin therapy

87
Q

Which lab value on BMP should you watch out for with sulfonamides?

A

Hyperkalemia

88
Q

T/F: Sulfonamides are cleared via the liver

A

False. Kidneys.

89
Q

Sulfonamides are bacteriocidal or bacteriostatic?

A

Bacteriostatic

90
Q

ADRs of sulfonamides?

A
  • Hypersensitivity rxn
  • Myelosuppression
  • Hemolytic anemia in G6PD deficiency
91
Q

Common tx indications for sulfonamides?

A
  • PCP PNA (ayyyy jiroveci *Italian accent*) and prophylaxis
  • UTI
  • MRSA skin and soft tissue infections
92
Q

Which abx are in the nitromidazole class and how are they given (PO/IV/IM)?

A
  • Metronidazole (Flagyl)
    • PO or IV
  • Tinidazole (Tindamax)
    • PO
93
Q

MOA of nitromidazoles?

A

DNA damage

94
Q
A
95
Q
A
96
Q
A
97
Q
A

RRCCPA Pharmacotherapeutics (11 decks)

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