Antimicrobial Review (Schoney) Flashcards by Cameron Santiago

What classes of antibiotics make up the Beta Lactams?

Penicillins
Extended spectrum penicillins
Cephalosporins
Carbapenems

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What form of Penicillin is IV/IM? What form is PO?

Pencillin G is IV/IM

Penicillin VK is PO

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What is the name for the long-acting IM version of penicillin?

Benzathine penicillin (Bicillin LA)

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The natural penicillins are Penicillin G, Penicillin VK, and Benzathine Penicillin.
What are they commonly used to treat?

Strep pharyngitis/cellulitis.

Syphilis (Benzathine penicillin)

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What are the aminopenicillins?

Ampicillin (IV) and Amoxicillin (PO)

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What are the aminopenicillins commonly used to treat?

Pharyngitis, sinusitis, otitis media, endocarditis prophylaxis, lyme dz (age <8)

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What are the anti-staphylococcal penicillins?

Nafcillin (IV) or dicloxacillin (PO)

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What are the anti-staphylococcal penicillins commonly used for?

Skin and soft tissue infections with suspected staph, also works against strep.

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What are the augmented penicillins?

Ampicillin/sulbactam (Unasyn) (IV), Amoxicillin/clavulanate (Augmentin) (PO), Piperacillin/tazobactam (Zosyn) (IV).

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What are the augmented penicillins commonly used for?

Amp/sulbactam and Amox/clav: Bites, otitis media, sinusitis, AECB, dental infections, skin and soft tissue infections.

Pip/tazo - Broad spectrum with pseudomonas coverage, used for hospitalized patients.

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What is the mechanism of action of penicillins?

Stops cell wall synthesis by binding pencillin binding protein.

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What is the mechanism of resistance to penicillins?

B lactamases and PBP alterations

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Are penicillins bacteriocidal or bacteristatic?

Bacteriocidal

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Are penicillins excreted through the kidneys are metabolized by the liver?

Kidneys

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What does the bacterial coverage for the cephalosporins look like?

1st generation has excellent gram + activity and poor gram - activity.
Gram + activity decreases as generations increase.
Gram - activity increases as generations increase.

Exception is next generation, which has broad coverage + MRSA coverage.

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What is the mechanism of action of cephalosporins?

Stops cell wall synthesis by binding PBP

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What is the mechanism of resistance for cephalosporins?

beta lactamases.

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What adverse reaction is linked to ceftriaxone?

Biliary sludging and pseudocholelithiasis

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What are the first generation cephalosporins?

Cefazolin (Ancef) (IV)

Cephalexin (Keflex) (PO)

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Do first generation cephalosporins cover MRSA or Pseudomonas?

Neither

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What are first generation cephalosporins commonly used for?

Skin and soft tissue infections, strep pharyngitis, pre op prophylaxis (cefazolin), and uncomplicated cystitis.

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What is a second generation cephalosporin?

Cefuroxime (Ceftin) (PO)

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What is cefuroxime commonly used for?

Otitis media, sinusitis, AECB, skin and soft tissue infections.

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What are the 3rd generation cephalosporins?

Ceftriaxone (Rocephin) (IM/IV)

Cefdinir (Omnicef) (PO)

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What attribute of ceftriaxone makes it a great drug for meningitis?

It can cross the blood brain barrier.

Do 3rd gen cephalosporins treat MRSA or pseudomonas?

Neither

What are 3rd gen cephalosporins commonly used to treat?

CAP Meningitis Gonorrhea (Plus azithromycin) Pyelonephritis

What is a 4th generation cephalosporin?

Cefepime (IV)

Do 4th gen cephalosporins treat MRSA or pseudomonas?

Yes, pseudomonas | No for MRSA.

What is a next generation (5th generation) cephalosporin?

Ceftaroline (Teflaro) (IV)

Do next generation cephalosporins cover MRSA or pseudomonas?

Yes - MRSA

What are the antibiotics is the tetracyclines class?

Tetracycline, minocycline, doxycycline

What is the mechanism of action for tetracyclines?

Protein synthesis inhibition at 30 S bacterial ribosomes.

What is the mechanism of resistance to tetracyclines?

Efflux pump

Are tetracyclines excreted by the kidneys or liver?

Split

Are tetracyclines bacteriocidal or bacteriostatic?

Bacteriostatic

What populations are tetracyclines contraindicated in?

Pregnant patients | Kids <8 years of age

What is an adverse reaction to tetracyclines you should know about?

Photosensitivity

What are tetracyclines commonly used to treat?

``` Sinusitis AECB CAP Non-gonococcal urethritis/cervicitis TICK BORNE disease ```

What medication should you be sure to not combine with tetracyclines?

Isotretinoin

What can the combination of tetracyclines and isotretinoin cause?

Pseudotumor cerebri

What medication are the macrolides?

Azithromycin, clarithromycin, erythromycin

What is the mechanism of action for macrolides?

Protein synthesis inhibition at 50 S ribosome

What is the mechanism of resistance to macrolides?

Ribosomal changes and efflux pump

Are macrolides bacteriostatic or bacteriocidal?

Bacteriostatic

What are macrolides commonly used for?

Pharyngitis, otitis media, CAP/atypical PNA, whooping cough (pertussis), Urethritis and cervicitis, and H. plyori.

What macrolide is a potent CTPA4 inhibitor? | Caution with warfarin

Clarithromycin

What macrolide is a potent CTPA4 inhibitor? | Caution with warfarin

Clarithromycin

What macrolide has a black box warning for QTC prolongation?

Azithromycin

What macrolide is a promotility agent?

Erythromycin

What macrolide is associated with a metallic taste?

Clarithromycin

Name 1 medication from the lincosamide class.

Clindamycin (IV or PO)

What is the mechanism of action of clindamycin?

Protein synthesis inhibition at 50 S ribosome.

What is the mechanism of resistance to lincosamides?

Ribosomal modification

Are lincosamides bacteriocidal or bacteriostatic?

Bacteriostatic.

Lincosamides are notorious for causing what GI infection?

C diff

What are lincosamides commonly used to treat?

Substitution for b lactam allergy for skin and soft tissue infections and strep pharyngitis. Anaerobic infections/abscesses. Dental infections

What medications make up the fluoroquinolone class? | Which are respiratory and which are non-respiratory?

Ciprofloxacin (PO, IV, drops) - non-respiratory. | Levofloxacin (PO

What is the mechanism of action of fluoroquinolones?

Inhibit bacterial DNA toposiomerases

What is the mechanism of resistance to fluoroquinolones?

Alteration in DNA topoisomerase

Are fluoroquinolones excreted by the kidneys or liver?

Split

Are fluoroquinolones bacteriocidal or bacteriostatic?

Bacteriocidal

What is ciprofloxacin commonly used for?

Complicated UTI (pyelonephritis, prostatitis) Enteric infections/traveler's diarrhea Diverticulitis (plus metronidazole)

What are respiratory fluoroquinolones (levofloxacin, moxifloxacin) commonly used for?

CAP | Pelvic infections

There are many adverse reactions associated with fluoroquinolones. Name some.

``` Arthropathy Tendinopathy CNS toxicity Photosensitivity QT prolongation Dysglycemia Neuropathy ```

What medications are the sulfonamides?

Trimethoprim/sufamethoxazole (Batrim or Septra) (IV or PO)

Do fluoroquinolones cover MRSA or psuedomonas?

Pseudomonas

Do the sulfonamides cover MRSA or pseudomonas?

MRSA

What is the mechanism of action for sulfonamides?

Inhibition of folate synthesis

Mechanism of resistance to sulfonamides?

Alteration in folate synthesis. | Decreased binding sites.

A patient taking warfarin recently started bactrim. How do you expect their INR to change?

Increase | Sulfonamides inhibit CYP2C9.

Are sulfonamides excreted by the kidneys or liver?

Kidneys

Are sulfonamides bacteriocidal or bacteriostatic?

Bacteriostatic.

What hematologic disorder is a contraindication to sulfonamides? Why?

G6PD deficiency | Hemolytic anemia

What are sulfonamides commonly used for?

PCP pneumonia and prophylaxis UTI MRSA and soft tissue infections

What are the nitromidazoles?

Metronidazole (Flagyl) (IV or PO) | Tinidazole (Tindamax) (PO)

What is the coverage for nitromidazoles?

Anaerobes below the diaphragm. | Protazoa.

Are nitromidazoles bacteriostatic or bacteriocidal?

Bacteriocidal

Are nitromidazoles excreted by the kidneys or liver?

Liver

What are nitromidazoles commonly used to treat?

Bacterial vaginosis, C diff, giardia, trichomoniasis, abdominopelvic infections

Name 3 adverse reactions to nitromidazoles.

Metallic taste Disulfram reaction Fetotoxic in 1st trimester

What are the aminoglycosides?

Gentamycin (IV), tobramycin (IV)`

Do aminoglycosides over MRSA or pseudomonas?

Pseudomonas

What is the mechanism of action for aminoglycosides?

Inhibit 30 S ribosome

What are the mechanisms of resistance to aminoglycosides?

Ribosomal modification and efflux mechanisms

Are aminoglycosides excreted by the liver or kidneys?

Kidneys

Are aminoglycosides bacteriocidal or bacteriostatic?

Bacteriocidal

Name 2 adverse reactions to aminoglycosides.

Nephrotoxicity | Ototoxicity

Name 1 medication from the glycopeptide class of antibiotics.

Vancomycin (IV and PO)

Does vancomycin cover pseudomonas or MRSA?

MRSA

What is the mechanism of action for vacomycin?

Inhibits cell wall synthesis

What is the mechanism of resistance to vancomycin?

Alteration in binding sites

Is vancomycin excreted through the kidneys or liver?

Kidneys

Why can't C diff be treated with parenteral vancomycin?

No systemic absorption of PO formulation

Is vancomycin bacteriostatic or bacteriocidal?

Bacteriocidal for gram + only.

Vancomycin infusions should be given over 1 hour to prevent?

Red man syndrome

What medications make up the cabapenem class of antibiotics?

Imipenem, meropenem, ertapenem (all IV only)

Do carbapenems cover MRSA or pseudomonas?

Pseudomonas for Imipenem and meropenem. | NOT ERTAPENEM

Mechanism of action for carbapenems?

Stops cell wall synthesis

Mechanisms of resistance to carbapenems?

carbapenemases

Adverse reactions to carbapenems?

Seizures | Nephrotoxicity

What are carbapenems commonly used for?

Ventilator associated PNA Resistant complicated UTI Nosocomial infections

Name 4 antimycobacterials.

Isoniazid Rifampin Pyrazinamide Ethambutol

What is the drug of choice for latent TB? | The PANCE answer, not the current answer

Isoniazid

What is the duration of therapy for latent TB treatment?

9 months

Adverse reactions to isoniazid?

Increased liver enzymes | Peripheral neuropathy

What antimycobacterial should be avoided with HIV meds?

Rifampin, because it is an inducer of CYP enzymes

What are 2 adverse reactions to rifampin?

Red lobster syndrome and elevated liver enzymes.

What antimycobacterial can cause color blindness?

Ethambutol

What medications make up the polyenes class of antifungals?

Amphotericin B | Nystatin

What is the most severe side effect to amphotericin B?

Nephrotoxicity

What topical medications are in the azoles class of antifungals?

Topical Skin: Clotrimazole (lotramin), miconazole Topical vaginal: terconazole, miconazole (monistat), tioconazole Topical oral: Clotrimazole (Mycelex), miconazole.

What systemic medications are in the azoles class of antifungals?

``` Ketoconazole Itraconazole Fluconazole Voriconazole Posaconazole ```

What is the only azole antifungal that can get into the bladder to treat fungal UTIs?

Fluconazole

Are azole antifungals excreted by the kidneys or liver?

Kidneys

What are azole antifungals commonly used for?

Candidal infections - vulvovaginitis, esophagitis

What medications are in the allylamines class of antifungals?

Tervinafine (Lamasil) (PO or topical)

What is terbinafine commonly used for?

Onychomycosis and cutaneous dermatophyte infections

What antibiotics are associated with nephrotoxicity?

Aminoglycosides (usually gentamicin) | Vancomycin

What antibiotics are associated with color findings?

Vancomycin -> red man syndrome Rifampin -> red lobster syndrome Discolored teeth -> tetracyclines Yellow babies ->sulfonamides

What antibiotics cause complications in pregnancy?

``` FAST Fluoroquinolones (arthropathy) Aminoglycosides (CN8 toxicity in fetus) Sulfonamides (Newborn kernicterus) Tetracyclines (Tooth/bone problems in infant) ```

``` What are the mediators for each of the following types of hypersensitivity reactions? Type I Type II Type III Type IV ```

Type I - IgE mediated Type II - IgG and complement mediated Type III - Antibody/antigen complexes Type IV - T cell mediated

Give an example reaction for each of the types of hypersensitivity reactions.

Type I - Urticaria or anaphylaxis Type II - Bone marrow suppression Type III - Serum sickness, PSGN Type IV - Stevens Johnson, toxic epidermal necrolysis, organ rejection.