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Pharmacotherapeutics - Fall 21 > Antimicrobial Review w/ Schoeny > Flashcards

Antimicrobial Review w/ Schoeny Flashcards

1
Q

List the Beta Lactams

A

Penicillins
Extended spectrum penicillins
Cephalosporins
Carbapenems

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2
Q

List the Non Beta Lactams

A 
Macrolides
Tetracyclines
Clindamycin
Aminoglycocides
Fluoroquinolones
Nitrofurantoin
Sulfonamides
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3
Q

Natural PCNs

A
  • Penicillin G(IV or IM) or Penicillin VK (PO)

- Benzathine Penicillin (long-acting IM)

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4
Q

Penicillin G or PCN VK is commonly used to treat?

A

-Strep pharyngitis/cellulitis

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5
Q

_______ is used to treat Syphilis

A

Benzathine Penicillin (Bicillin LA)

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6
Q

Primary Syphilis Sx:

A

sore or sores at the original site of infection. These sores usually occur on or around the genitals, around the anus or in the rectum, or in or around the mouth, sores are firm/round/ painless.

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7
Q

Secondary Syphilis Sx:

A

maculopapular skin rash, swollen lymph nodes, and fever. Money spots on palms of hands/feet

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8
Q

List the Aminopenicillins

A

Ampicillin(IV) or amoxicillin (po)

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9
Q

What do aminopenicillins cover?

A

Coverage: Strep pyogenes (group A strep infections), Strep agalactaie, Strep pneumonia, Enterococci, Borrelia burgdorferi, Listeria

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10
Q

Aminopenicillins: commonly used to treat?

A

Pharyngitis, sinusitis, otitis media, endocarditis prophylaxis, Lyme dx (age <8 years)

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11
Q

Anti-staph PCNs:

-list two and their formulations

A

Nafcillin (IV) or dicloxacillin (PO)

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12
Q

Anti-Staphylococcal Penicillins

are commonly used to treat?

A

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

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13
Q

Child (7 yo) was recently diagnosed with lyme disease. What tx is appropriate?

A

amoxicillin for kids <8 yo

borrelia burgdorferi

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14
Q

Where does listeria originate?

-What is Listeria’s WORST complication?

A

contaminated soft cheeses like brie—or cantaloupe in CO! and unpasteurized dairy products. Listeria is a food borne illness that causes diarrhea, severe dehydration, the worst complication is Meningitis!!!!!!! Esp young kids/elderly. It can also cause miscarriages in pregnancy –if someone presents to the ER with meningeal symptoms and there has been a listeria outbreak– MUST give them an aminopenicillin

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15
Q

Are Nafcillin (IV) or dicloxacillin (PO) good for MRSA infections?

A

NO, minimal staph coverage

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16
Q

List the Augmented Aminopenicillins

A

Ampicillin/sulbactim (Unasyn IV) or amoxicillin/clavulanate (Augmentin PO)

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17
Q

Coverage for the Augmented Aminopenicillins:

A

Same as aminopenicillins plus Pasteurella, Moraxella, Haemophilus influenza, anaerobes

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18
Q

Augmented Aminopenicillins are MC used to treat:

A
  • Bites
  • Otitis media, sinusitis, acute exacerbation of chronic bronchitis
  • Dental infections
  • Skin and soft tissue infections

**Pasteurella from animal bites!!! (cat and dog), respiratory infections like bacterial sinusitis

COPD—acute exacerbations of bronchitis-–H influenzae is BIG player

Skin and soft tissue infections BUT NO MRSA coverage

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19
Q

Augmented Extended-Spectrum Penicillins: list

-coverage and typical Pt population this abx is used?

A
  • Piperacillin/tazobactam (Zosyn IV)
  • *Broad spectrum w/ Pseudomonas coverage–> think hospitalized Pts!
  • Zoysn is broad spectrum– gram + and – and good pseudamonas coverage, used in hospital Pts, BUT no MRSA coverage
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20
Q

PCNs MOA:

A

stops cell wall synthesis by binding penicillin binding protein

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21
Q

PCNs MOR:

A

B lactamases and PBP alterations

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22
Q

PCNs Pharmacology

A
  • Renal

- Bacteriocidal

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23
Q

Bacteriostatic vs bacteriocidal

A

Bacteriostatic: slows growth of the bacteria, but doesn’t kill it all off, relies on working with the Pt’s immune system to also help fight the infection
Vs
Bacteriosidal: KILLS the bacteria, so it cant mutate

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24
Q

PCNs

-List ADRs (clavulanate is associated with _____**)

A
  • Hypersensitivity Reactions

- Clavulanate assoc. w/ diarrhea and subclinical hepatotoxicity

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25
Q

Cephalosporins are classified by:

A

generations! 1st-5th

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26
Q

Cephalosporin generalized rule regarding the generations and coverage:

A
  • 1st generation has excellent gram positive activity and poor gram negative activity.
  • Gram positive activity decreases as generations increase
  • Gram negative activity increases as generations increase
  • 4 generations + next generation
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27
Q

EXCEPTION to the cephalosporin rule

A

** Next generation(ceftaroline) has broad coverage AND MRSA coverage

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28
Q

Cephalosporins: MOA

A

stops cell wall synthesis by binding penicillin binding protein

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29
Q

Cephalosporins: MOR

A

beta-lactamases

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30
Q

Cephalosporins: ADR

A

Ceftriaxone (3rd gen) linked with biliary sludging /pseudocholelithiasis

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31
Q

List the 1st gen cephalosporins and formulations

A

Cefazolin (Ancef IV) or cephalexin (Keflex po)

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32
Q

1st gen cephalosporins: coverage?

A
  • *Coverage: gram positives excellent EXCEPT MRSA, minimal gram negative coverage
  • Strep pyogenes, MSSA
  • Some E coli, Klebsiella, Proteus
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33
Q

1st gen cephalosporins:

Common tx indications?

A
  • Skin and soft tissue infections
  • Strep pharyngitis
  • Pre op prophylaxis (cefazolin)
  • Uncomplicated cystitis
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34
Q

2nd Generation cephalosporins: list

A

Cefuroxime (Ceftin po)

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35
Q

Cefuroxime (ceftin) coverage ?

A

Covers same as 1st generation (gram positives excellent EXCEPT MRSA, minimal gram negative coverage) plus Strep pneumonia, Moraxella catarrhalis, Haemophilus influenza (respiratory)

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36
Q

2nd Generation cephalosporins: Common tx indications?

A 
(Cefuroxime) 
Otitis media
Sinusitis
-Acute exacerbations of chronic bronchitis
-Skin and soft tissue infections
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37
Q

3rd generation cephalosporins: list

A

Ceftriaxone (Rocephin IM or IV), cefdinir (Omnicef PO)

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38
Q

3rd generation cephalosporins: coverage?

A

gram negative with some gram positive- NOT enterococcus or MRSA
**Ceftriaxone crossed blood brain barrier–> can be used for empiric meningitis tx (BUT not for listeria meningitis) . Also good for CAP and gonorrhea

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39
Q

3rd generation cephalosporins: common tx indications

A

CAP
Meningitis
Gonorrhea (with Azithromycin)
Pyelonephritis

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40
Q

New tx regimen for chlamydia and gonorrhea

A

New tx for gonorrhea– ceftriaxone 500 mg IM by itself NO azithromycin

Same with chlamydia– now doxycycline 100 mg PO BID x 7 days is TOC for chlamydia. *Azithromycin is now alternative

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41
Q

4th generation Cephalosporins: list

A

Cefepime (IV)

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42
Q

4th generation Cephalosporins: coverage

A

most gram negative rods, more resistant gram negatives>Pseudomonas
**4th gen MC used in hospital setting (cefepime IV)

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43
Q

5th gen cephalosporin: list

A

Ceftaroline(Teflaro IV)

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44
Q

5th gen cephalosporin: coverage?

A
  • very broad gram negative and gram positive coverage
  • **MRSA coverage

-Pneumonia and skin and soft tissue infections

BUT NO pseudomonas

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45
Q

Tetracyclines: list

A

Tetracycline, minocycline, doxycycline (PO,IV)

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46
Q

Tetracyclines: coverage

A

Step pneumo, Moraxella catarrhalis, H influenza, Chlamydia, Legionella, Mycoplasma, Rickettsia, Ehrlichia, Borellia, Staph aureus including MRSA

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47
Q

Tetracyclines: MOA**

A

protein synthesis inhibition at **30 S bacterial ribosome

MOR:efflux pump

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48
Q

Tetracyclines: MOR

-pharmacology?

A

efflux pump

Pharmacology:
Split excretion
bacteriostatic

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49
Q

Tetracyclines: ADRs

A
  • Photosensitivity

- **Contraindicated in pregnancy/kids <8 years of age

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50
Q

Tetracyclines: common tx indications

A 
Sinusitis
Acute Exacerbations of chronic bronchitis
CAP
Non gonococcal urethritis/cervicitis
TICK BORNE disease (Lyme, Rickettsia)
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51
Q

Tetracyclines SHOULD NOT be combined with ______

A

**isotretinoin–>can cause pseudotumor cerebri

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52
Q

______ decreases tetracyclines absorption

A

calcium

**do not let pts take calcium supplements

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53
Q

Macrolides: list

A

Azithromycin, clarithromycin, erythromycin ( po or IV)

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54
Q

Macrolides: coverage

A

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

pertussis= azithromycin

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55
Q

Macrolides: MOA

A

protein synthesis inhibition at **50S ribosome

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56
Q

Macrolides: MOR

A

ribosomal changes and efflux pump

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57
Q

Macrolides: pharm

note: clarithromycin is a potent ______ inhibitor

A
  • Bacteriostatic
  • Safety concerns: Clarithromycin potent CYPA4 inhibitor–> monitor warfarin

-QTC prolongation—> azithromycin has new black box warning

58
Q

Macrolides:: ADRs

  • erythromycin?
  • clarithromycin?
A
  • Erythromycin–>promotility agent–> causes nausea/vomiting/diarrhea
  • Clarithromycin=metallic taste
59
Q

Macrolides: common tx indications

A 
Pharyngitis
Otitis media
Community acquired pneumonia/atypical pneumonia(Mycoplasma)
Whooping cough-pertussis
Urethritis and cervicitis
H pylori
60
Q

Lincosamides: list

A

Clindamycin (IV or PO)

61
Q

Lincosamides: coverage

A

anaerobes (above diaphragm), Staph aureus and Strep pyogenes in PCN allergic patients

62
Q

Lincosamides: MOA

A

protein synthesis inhibition at 50 S ribosome

63
Q

Lincosamides:MOA

A

ribosomal modification

64
Q

Lincosamides: Pharmacology

A

Bacteriostatic

65
Q

Lincosamides: ADRs

A

Diarrhea/Nausea

C diff

66
Q

Which abx is known to cause C diff?

A

**clindamycin

67
Q

lincosamides: Common tx indications?

A
  • Substitute for serious b lactam allergy in skin and soft tissue infections and strep pharyngitis
  • Anaerobic infections/abscesses
  • Dental infections (clinda)
68
Q

Fluoroquinolones:

non-respiratory (list)

A

**Ciprofloxacin (PO,IV, drops)

69
Q

Ciprofloxacin covers __________

A

most gram negative rods including Pseudomonas

70
Q

Fluoroquinolones: respiratory

A

Levofloxacin (PO

71
Q

Respiratory fluoroquinolones coverage

A

Coverage: same as Cipro plus increased activity for Strep pneumo and atypical respiratory pathogens

72
Q

Fluoroquinolones: MOA

A

inhibit bacterial DNA topoisomerases

73
Q

Fluoroquinolones: MOR

A

alteration in DNA topoisomerase

74
Q

Fluoroquinolones: Pharm

  • Cidal or static?
  • ____ and ____ decrease absorption
  • EKG findings associated with fluoroquinolones?
A
  • Split excretion
  • Bacteriocidal
  • Ca and Mg decrease absorption
  • QTC prolongation KNOW
75
Q

Fluoroquinolones: common tx indications

non-respiratory–>

A
  • Complicated UTI (pyelonephritis, prostatitis)
  • Enteric infections/traveler’s diarrhea
  • Diverticulitis (plus metronidazole)
76
Q

Fluoroquinolones: common tx indications

Respiratory–>

A
  • Community acquired pneumonia

- Pelvic infections

77
Q

Fluoroquinolones: ADRs (hint: there are LOTs)

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
78
Q

Sulfonamides: list ex’s and formulations

A

Trimethoprim/sulfamethoxazole (Bactrim or Septra IV or PO)

79
Q

Sulfonamides: coverage?

A
  • gram negative and gram positive coverage including MRSA
  • E coli, Klebsiella, Proteus, MRSA
  • Pneumocystis jiroveci
  • H influenza, Moraxella catarrhalis
80
Q

Sulfonamides: MOA

A

inhibition of folate synthesis

81
Q

Sulfonamides: MOR

A

alteration in folate synthesis, decreased binding sites

82
Q

Sulfonamides: Pharm?

  • -inhibit ______ and increase _____
  • Retention of _______
A

**Inhibit CYP2C9-INCREASE INR in warfarin therapy
**Retention of potassium
(MUST check K+ and INR if pt is on bactrim)
-Renal excretion
-bacteriostatic

83
Q

Sulfonamides: ADRs

A
  • Hypersensitivity rxn
  • Myelosuppression
  • Hemolytic anemia in G6PD deficiency
84
Q

Sulfonamides: common tx indications?

A
  • PCP pneumonia and prophylaxis
  • UTI
  • MRSA skin and soft tissue infections
85
Q

nitromidazoles: list ex’s and formulations

A

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

86
Q

nitromidazoles: Coverage?

A

anaerobes below the diaphragm, protozoa (giardia etc

87
Q

nitromidazoles: MOA? MOR?

A

MOA:DNA damage
MOR: not known

88
Q

nitromidazoles: Pharm

A

Hepatic

bacteriocidal

89
Q

nitromidazoles: ADRS

A
  • Metallic taste
  • Disulfram rxn
  • **Fetotoxic in 1st trimester
90
Q

nitromidazoles: common tx indications

A

Bacterial vaginosis, C diff, giardia, and trichomoniasis, abdominopelvic infections ( plus another abx

91
Q

Aminoglycosides: list ex’s and forms

A

Gentamicin, tobramycin (IV)

92
Q

Aminoglycosides: coverage?

A
  • gram negative including Pseudomonas

- Mostly for nosocomial infections

93
Q

Aminoglycosides: MOA

A

inhibit 30 S ribosome

94
Q

Aminoglycosides: MOR

A

ribosomal modification and efflux mechanisms

95
Q

Aminoglycosides: Pharm

  • How is it excreted?
  • _____Therapeutic window
A
  • Renal excretion
  • *Narrow Therapeutic window-measure troughs
  • bacteriocidal
96
Q

Aminoglycosides: ADR

A
  • Nephrotoxicity (reversible)

- ototoxicity (hearing loss is urually irreversible!! watch out w/ gentamycin)

97
Q

Glycopeptides: list ex’s and formulations

A

Vancomycin (IV and PO)

98
Q

Glycopeptides: Coverage?

A

**oral-C diff

-IV –MRSA infections and other serious gram positive infections

99
Q

Glycopeptides:

  • Excretion route?
  • Trough target _____
  • cidal or static?
A

Renal excretion

  • Trough target 10-20
  • Bacteriocidal gram positive organism only
100
Q

Glycopeptides: MOA and MOR?

A

MOA:inhibits cell wall synthesis

MOR:alterations in binding sites

101
Q

Glycopeptides:
Infuse over _____ hours in order to avoid “Red man syndrome”
-other ADRs?

A

Vanco=red man syndrome**
*1 hour

-ototoxicity, nephrotoxicity, Red Man Syndrome

102
Q

Glycopeptides:

describe the oral absorption of PO formulation

A

NO oral absorption

KNOW– PO vanco is used almost exclusively for c diff infections

103
Q

Carbapenems: list ex’s and forms

A

Imipenem,meropenem,ertapenem (IV)

104
Q

Carbapenems: Coverage?

A

broad spectrum with Pseudomonas coverage **EXCEPT ertapenem

105
Q

Carbapenems: MOA and MOR

A

MOA: stops cell wall synthesis

MOR:carbapenamases

106
Q

Carbapenems: ADRs

A

Seizures

nephrotoxicity

107
Q

Carbapenems: common tx indications

A

Ventilator associated pneumonia

Resistant complicated UTI

Nosocomial infections

108
Q

Antimycobacterials:

Isoniazid is the DOC for tx of ______

A
  • *latent TB-now changed due to treatment guideline update Feb 2020 but still may be on PANCE
  • 9 months of therapy for latent TB
  • 1 of meds for treatment of active TB
109
Q

Antimycobacterials:

Isoniazid- ADRs?

A
  • Increased liver enzymes

- **Peripheral neuropathy

110
Q

antimycobacterials:

Rifampin is used to tx _____

A

Latent TB-part of first line regimen in Feb 2020 updates

-Part of multidrug regimen for active TB treatment

111
Q

antimycobacterials: Rifampin should be avoided with ____ meds

A

Inducer of CYP enzymes- **avoid with HIV meds

112
Q

antimycobacterials: Rifampin

- ADRs?

A

Red Lobster syndrome and elevated liver enzymes can occur

113
Q

List 2 ex tx regimens for latent TB

A
  • Isoniazid & Rifapentine for 3 months, dose once weekly
  • Rifampin for 4 months, take daily
  • Isoniazid and Rifampin for 3 months, take daily

Alt: Isoniazid for 6 months, take daily

114
Q

Antimycobacterials:

Pyrazinamide- ADRs?

A

Polyarthralgias can occur

-Part of multidrug regimen for treatment of active TB

115
Q

Antimycobacterials: Ethambutol ADRs

A

**Color blindness common adverse drug effect (Ethambutol –E for eye– monitor them periodically with ishehara color blind test, make sure they aren’t going color blind)

-Part of multidrug regimen for tx of active TB

116
Q

Antifungals:
Polyenes: list

A

Amphotericin B
&
Nystatin

117
Q

Antifungals:
Amphotericin B is used to tx ______

-ADR??

A

resistant or deep fungal infections

**NEPHROTOXIC– high rate of nephrotoxicity

118
Q

Antifungals: Nystatin is used to tx______

A

Topical powder or mouthwash

Use for thrush or intertrigo

119
Q

Antifungals: azoles

-topical skin?

A

clotrimazole (lotrimin) ,miconazole

120
Q

Antifungals: azoles

topical vaginal?

A

terconazole, miconazole (monistat), tioconazole

121
Q

Antifungals: azoles

-topical oral?

A

clotrimazole (Mycelex) , miconazole

122
Q

Antifungals: azoles

-systemic?

A 
Ketoconazole
Itraconazole
***Fluconazole
Voriconazole
Posaconazole
123
Q

Azoles:

  • inhibits _____
  • excretion?
  • EKG finding?
A
  • Inhibits CYP2C9 (warfarin)
  • Renal excretion
  • Qt prolongation
124
Q

Azoles: common tx indications

A

-Candidal infections-vulvovaginitis, esophagitis

-Fluconazole is only azole antifungal that gets into bladder –> fungal UTI treatment
monitor INR levels*

125
Q

Allylamines: Terbinafine

  • ADR?
  • Used to tx______
A

Terbinafine (Lamisil po or topical)

  • Hepatotoxic
  • Used for onychomycosis and cutaneous dermatophyte infections
126
Q

What abx are assoc. with nephrotoxicity?

A

Aminoglycosides–>usually gentamicin,

Vancomycin

127
Q

Antibiotics associated with color findings:

  • red man syndrome?
  • Red lobster syndrome?
  • Discolored teeth?
  • Yellow babies?
A
  • Red man syndrome=vancomycin
  • Red lobster syndrome=rifampin

-Discolored teeth-tetracyclines

Yellow babies-sulfonamides

128
Q

Which categories are safe in pregnancy?

A

A and B

129
Q

Cat B meds:

A

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

130
Q

Cat C meds:

A

Fluoroquinolones
Clarithromycin
Tmp/smx

131
Q

Cat D meds:

A

Aminoglycosides
Tetracyclines

WE SHOULD NOT USE IN pregnancy

132
Q

Potential ABX complications in Pregnancy:

FAST (aka abx you dont use in pregnancy)

A

Fluoroquinolones–> artrhopathy

Aminoglycosides–> Possible CN8 toxicity in fetus

Sulfonamides–> Newborn kernicterus

Tetracyclines–> Tooth/bone problems for infant

133
Q

Type 1 hypersens rxn:

A

IgE mediated>anaphylaxis/urticaria

134
Q

Type 2 hypersensitivity rxn:

A

IgG and complement mediated->can cause bone marrow suppression

135
Q

Type 3

A

Antibody /antigen complexes–> assoc. with serum sickness/post streptococcal glomerulonephritis

136
Q

Type 4

A

T cell>delayed hypersensitivity rxn–> Ex’s: stevens Johnson/toxic epidermal necrolysis/organ rejection

137
Q

What are good oral options for skin infections?

A

Cephalexin and Bactrim main ones. Other good oral options: dicloxacillin (but no mrsa coverage)

138
Q

What are good oral options for MRSA infections? IV?

A

Bactrim, Ceftaroline (Teflaro) IV, linezolid (expensive PO option), doxycycline (oral), Vanco (IV-ONLY), Clindamycin

139
Q

When would you use IV vs oral?

A

IV formulations for more serious type infections, or infections that haven’t responded to PO therapy, often times hospitalized Pts. PO abx are often in outpatient settings.

140
Q

What are good oral options for gram negative infections?

A

Cefdinir (PO)-3rd gen, fluoroquinolones-cipro,

-Cephalexin might work for E coli infection,

141
Q

What are good oral options for Pseudomonas infections?

A

**Fluoroquin– cipro or levo only, moxi not good

142
Q

What are good IV options for Pseudomonas infections?

A

Carbapenems except ertapenem, pip-taz, aminoglycosides- genta, tobramycin, amacasin, cefepime (4th gen)

Pharmacotherapeutics - Fall 21 (7 decks)

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