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Cam's Cards > Antimicrobial Review (Schoney) > Flashcards

Antimicrobial Review (Schoney) Flashcards

1
Q

What classes of antibiotics make up the Beta Lactams?

A

Penicillins
Extended spectrum penicillins
Cephalosporins
Carbapenems

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2
Q

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

A

Pencillin G is IV/IM

Penicillin VK is PO

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3
Q

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

A

Benzathine penicillin (Bicillin LA)

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4
Q

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

A

Strep pharyngitis/cellulitis.

Syphilis (Benzathine penicillin)

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5
Q

What are the aminopenicillins?

A

Ampicillin (IV) and Amoxicillin (PO)

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6
Q

What are the aminopenicillins commonly used to treat?

A

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

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7
Q

What are the anti-staphylococcal penicillins?

A

Nafcillin (IV) or dicloxacillin (PO)

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8
Q

What are the anti-staphylococcal penicillins commonly used for?

A

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

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9
Q

What are the augmented penicillins?

A

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

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10
Q

What are the augmented penicillins commonly used for?

A

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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11
Q

What is the mechanism of action of penicillins?

A

Stops cell wall synthesis by binding pencillin binding protein.

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12
Q

What is the mechanism of resistance to penicillins?

A

B lactamases and PBP alterations

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13
Q

Are penicillins bacteriocidal or bacteristatic?

A

Bacteriocidal

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14
Q

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

A

Kidneys

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15
Q

What does the bacterial coverage for the cephalosporins look like?

A

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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16
Q

What is the mechanism of action of cephalosporins?

A

Stops cell wall synthesis by binding PBP

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17
Q

What is the mechanism of resistance for cephalosporins?

A

beta lactamases.

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18
Q

What adverse reaction is linked to ceftriaxone?

A

Biliary sludging and pseudocholelithiasis

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19
Q

What are the first generation cephalosporins?

A

Cefazolin (Ancef) (IV)

Cephalexin (Keflex) (PO)

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20
Q

Do first generation cephalosporins cover MRSA or Pseudomonas?

A

Neither

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21
Q

What are first generation cephalosporins commonly used for?

A

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

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22
Q

What is a second generation cephalosporin?

A

Cefuroxime (Ceftin) (PO)

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23
Q

What is cefuroxime commonly used for?

A

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

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24
Q

What are the 3rd generation cephalosporins?

A

Ceftriaxone (Rocephin) (IM/IV)

Cefdinir (Omnicef) (PO)

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25
Q

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

A

It can cross the blood brain barrier.

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26
Q

Do 3rd gen cephalosporins treat MRSA or pseudomonas?

A

Neither

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27
Q

What are 3rd gen cephalosporins commonly used to treat?

A

CAP
Meningitis
Gonorrhea (Plus azithromycin)
Pyelonephritis

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28
Q

What is a 4th generation cephalosporin?

A

Cefepime (IV)

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29
Q

Do 4th gen cephalosporins treat MRSA or pseudomonas?

A

Yes, pseudomonas

No for MRSA.

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30
Q

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

A

Ceftaroline (Teflaro) (IV)

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31
Q

Do next generation cephalosporins cover MRSA or pseudomonas?

A

Yes - MRSA

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32
Q

What are the antibiotics is the tetracyclines class?

A

Tetracycline, minocycline, doxycycline

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33
Q

What is the mechanism of action for tetracyclines?

A

Protein synthesis inhibition at 30 S bacterial ribosomes.

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34
Q

What is the mechanism of resistance to tetracyclines?

A

Efflux pump

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35
Q

Are tetracyclines excreted by the kidneys or liver?

A

Split

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36
Q

Are tetracyclines bacteriocidal or bacteriostatic?

A

Bacteriostatic

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37
Q

What populations are tetracyclines contraindicated in?

A

Pregnant patients

Kids <8 years of age

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38
Q

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

A

Photosensitivity

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39
Q

What are tetracyclines commonly used to treat?

A 
Sinusitis
AECB
CAP
Non-gonococcal urethritis/cervicitis
TICK BORNE disease
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40
Q

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

A

Isotretinoin

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41
Q

What can the combination of tetracyclines and isotretinoin cause?

A

Pseudotumor cerebri

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42
Q

What medication are the macrolides?

A

Azithromycin, clarithromycin, erythromycin

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43
Q

What is the mechanism of action for macrolides?

A

Protein synthesis inhibition at 50 S ribosome

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44
Q

What is the mechanism of resistance to macrolides?

A

Ribosomal changes and efflux pump

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45
Q

Are macrolides bacteriostatic or bacteriocidal?

A

Bacteriostatic

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46
Q

What are macrolides commonly used for?

A

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

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47
Q

What macrolide is a potent CTPA4 inhibitor?

Caution with warfarin

A

Clarithromycin

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47
Q

What macrolide is a potent CTPA4 inhibitor?

Caution with warfarin

A

Clarithromycin

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48
Q

What macrolide has a black box warning for QTC prolongation?

A

Azithromycin

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49
Q

What macrolide is a promotility agent?

A

Erythromycin

50
Q

What macrolide is associated with a metallic taste?

A

Clarithromycin

51
Q

Name 1 medication from the lincosamide class.

A

Clindamycin (IV or PO)

52
Q

What is the mechanism of action of clindamycin?

A

Protein synthesis inhibition at 50 S ribosome.

53
Q

What is the mechanism of resistance to lincosamides?

A

Ribosomal modification

54
Q

Are lincosamides bacteriocidal or bacteriostatic?

A

Bacteriostatic.

55
Q

Lincosamides are notorious for causing what GI infection?

A

C diff

56
Q

What are lincosamides commonly used to treat?

A

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

57
Q

What medications make up the fluoroquinolone class?

Which are respiratory and which are non-respiratory?

A

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

Levofloxacin (PO

58
Q

What is the mechanism of action of fluoroquinolones?

A

Inhibit bacterial DNA toposiomerases

59
Q

What is the mechanism of resistance to fluoroquinolones?

A

Alteration in DNA topoisomerase

60
Q

Are fluoroquinolones excreted by the kidneys or liver?

A

Split

61
Q

Are fluoroquinolones bacteriocidal or bacteriostatic?

A

Bacteriocidal

62
Q

What is ciprofloxacin commonly used for?

A

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

63
Q

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

A

CAP

Pelvic infections

64
Q

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

A 
Arthropathy
Tendinopathy
CNS toxicity
Photosensitivity
QT prolongation
Dysglycemia
Neuropathy
65
Q

What medications are the sulfonamides?

A

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

66
Q

Do fluoroquinolones cover MRSA or psuedomonas?

A

Pseudomonas

67
Q

Do the sulfonamides cover MRSA or pseudomonas?

A

MRSA

68
Q

What is the mechanism of action for sulfonamides?

A

Inhibition of folate synthesis

69
Q

Mechanism of resistance to sulfonamides?

A

Alteration in folate synthesis.

Decreased binding sites.

70
Q

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

A

Increase

Sulfonamides inhibit CYP2C9.

71
Q

Are sulfonamides excreted by the kidneys or liver?

A

Kidneys

72
Q

Are sulfonamides bacteriocidal or bacteriostatic?

A

Bacteriostatic.

73
Q

What hematologic disorder is a contraindication to sulfonamides? Why?

A

G6PD deficiency

Hemolytic anemia

74
Q

What are sulfonamides commonly used for?

A

PCP pneumonia and prophylaxis
UTI
MRSA and soft tissue infections

75
Q

What are the nitromidazoles?

A

Metronidazole (Flagyl) (IV or PO)

Tinidazole (Tindamax) (PO)

76
Q

What is the coverage for nitromidazoles?

A

Anaerobes below the diaphragm.

Protazoa.

77
Q

Are nitromidazoles bacteriostatic or bacteriocidal?

A

Bacteriocidal

78
Q

Are nitromidazoles excreted by the kidneys or liver?

A

Liver

79
Q

What are nitromidazoles commonly used to treat?

A

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

80
Q

Name 3 adverse reactions to nitromidazoles.

A

Metallic taste
Disulfram reaction
Fetotoxic in 1st trimester

81
Q

What are the aminoglycosides?

A

Gentamycin (IV), tobramycin (IV)`

82
Q

Do aminoglycosides over MRSA or pseudomonas?

A

Pseudomonas

83
Q

What is the mechanism of action for aminoglycosides?

A

Inhibit 30 S ribosome

84
Q

What are the mechanisms of resistance to aminoglycosides?

A

Ribosomal modification and efflux mechanisms

85
Q

Are aminoglycosides excreted by the liver or kidneys?

A

Kidneys

86
Q

Are aminoglycosides bacteriocidal or bacteriostatic?

A

Bacteriocidal

87
Q

Name 2 adverse reactions to aminoglycosides.

A

Nephrotoxicity

Ototoxicity

88
Q

Name 1 medication from the glycopeptide class of antibiotics.

A

Vancomycin (IV and PO)

89
Q

Does vancomycin cover pseudomonas or MRSA?

A

MRSA

90
Q

What is the mechanism of action for vacomycin?

A

Inhibits cell wall synthesis

91
Q

What is the mechanism of resistance to vancomycin?

A

Alteration in binding sites

92
Q

Is vancomycin excreted through the kidneys or liver?

A

Kidneys

93
Q

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

A

No systemic absorption of PO formulation

94
Q

Is vancomycin bacteriostatic or bacteriocidal?

A

Bacteriocidal for gram + only.

95
Q

Vancomycin infusions should be given over 1 hour to prevent?

A

Red man syndrome

96
Q

What medications make up the cabapenem class of antibiotics?

A

Imipenem, meropenem, ertapenem (all IV only)

97
Q

Do carbapenems cover MRSA or pseudomonas?

A

Pseudomonas for Imipenem and meropenem.

NOT ERTAPENEM

98
Q

Mechanism of action for carbapenems?

A

Stops cell wall synthesis

99
Q

Mechanisms of resistance to carbapenems?

A

carbapenemases

100
Q

Adverse reactions to carbapenems?

A

Seizures

Nephrotoxicity

101
Q

What are carbapenems commonly used for?

A

Ventilator associated PNA
Resistant complicated UTI
Nosocomial infections

102
Q

Name 4 antimycobacterials.

A

Isoniazid
Rifampin
Pyrazinamide
Ethambutol

103
Q

What is the drug of choice for latent TB?

The PANCE answer, not the current answer

A

Isoniazid

104
Q

What is the duration of therapy for latent TB treatment?

A

9 months

105
Q

Adverse reactions to isoniazid?

A

Increased liver enzymes

Peripheral neuropathy

106
Q

What antimycobacterial should be avoided with HIV meds?

A

Rifampin, because it is an inducer of CYP enzymes

107
Q

What are 2 adverse reactions to rifampin?

A

Red lobster syndrome and elevated liver enzymes.

108
Q

What antimycobacterial can cause color blindness?

A

Ethambutol

109
Q

What medications make up the polyenes class of antifungals?

A

Amphotericin B

Nystatin

110
Q

What is the most severe side effect to amphotericin B?

A

Nephrotoxicity

111
Q

What topical medications are in the azoles class of antifungals?

A

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

112
Q

What systemic medications are in the azoles class of antifungals?

A 
Ketoconazole
Itraconazole
Fluconazole
Voriconazole
Posaconazole
113
Q

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

A

Fluconazole

114
Q

Are azole antifungals excreted by the kidneys or liver?

A

Kidneys

115
Q

What are azole antifungals commonly used for?

A

Candidal infections - vulvovaginitis, esophagitis

116
Q

What medications are in the allylamines class of antifungals?

A

Tervinafine (Lamasil) (PO or topical)

117
Q

What is terbinafine commonly used for?

A

Onychomycosis and cutaneous dermatophyte infections

118
Q

What antibiotics are associated with nephrotoxicity?

A

Aminoglycosides (usually gentamicin)

Vancomycin

119
Q

What antibiotics are associated with color findings?

A

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

120
Q

What antibiotics cause complications in pregnancy?

A 
FAST
Fluoroquinolones (arthropathy)
Aminoglycosides (CN8 toxicity in fetus)
Sulfonamides (Newborn kernicterus)
Tetracyclines (Tooth/bone problems in infant)
121
Q 
What are the mediators for each of the following types of hypersensitivity reactions?
Type I
Type II
Type III
Type IV
A

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

122
Q

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

A

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

Cam's Cards (103 decks)

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