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Pharmacology > Antimicrobial Therapy > Flashcards

Antimicrobial Therapy Flashcards

1
Q

CNS Toxicity

A

PCN, cephalosporins, quinolones, imipenem

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2
Q

Hematologic toxicity w/ prolonged use

A

Nafcillin, piperacillin, cefotetan, chloramphenicol, trimethoprim

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3
Q

Reversible nephrotoxicity

A

Aminoglycosides & vancomycin

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4
Q

Photosensitivity

A

Azithromycin, quinolones, tetracyclines, pyrazinamide, sulfamethoxazole, and trimethoprim

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5
Q

Penicillins: moa

A

MOA: inhibit the growth of sensitive bacteria by inactivating enzymes located in the bacterial cell membrane

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6
Q

PCNs pathogens covered

A

-Gram +, gram -, most anaerobes

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7
Q

PCNs ADR & Monitoring

A

hypersensitivity, rash, drug fever, GI effects, hepatitis, interstitial nephritis, leukopenia, thrombocytopenia, Coomb’s (+) hemolytic anemia, C.Diff, electrolyte changes, seizures
-monitor: hypersensitivity reactions, renal function, hepatic function, CBC

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8
Q

PCN drugs

A
  • Broad spectrum
  • Amoxicillin
  • Ampicillin
  • Dicloxacillin
  • Nafcillin
  • Oxacillin
  • Penicillin G, V (more narrow)
  • Piperacillin
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9
Q

Cephalosporins MOA

A

inhibit the growth of sensitive bacteria by inactivating enzymes located in the bacterial cell membrane

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10
Q

Cephalosporin common pathogens covered

A

5 generations with increasing coverage; gram (+) cocci (minus enterococcus), gram (-) coverage.

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11
Q

Cephalosporin ADR & Monitoring

A

hypersensitivity, rash, drug fever, GI effects, hepatitis, interstitial nephritis, leukopenia, thrombocytopenia, Coomb’s (+) hemolytic anemia, C.Diff, coagulopathy

  • monitoring: hypersensitivity reactions & rash, renal function, hepatic function, CBC
  • Of note: do not use in patients with hx of IgE mediated allergy to PCN
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12
Q

List of Cephalosporin Drugs 1st generation

A
  • Good for bone infections, ear infections, skin infections, URIs and UTIs
  • Cephalexin (keflex, Biocef)
  • cefadroxil (Duricef)
  • cephradine (Panixine)
  • cefazolin (ancef)
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13
Q

Cephalosporin drugs: 2nd generation

A
  • Bone & joint infections, gynecological, intra-abdominal, lower respiratory, skin and skin structures infections, UTIs
  • More active against gram negative
  • cefuroxime (Ceftin)
  • cefprozil (Cefzil)
  • cefoxitin (Mefoxin)
  • cefuroxime (Zinacef)
  • cefotetan (efotan)
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14
Q

Cephalosporin drugs: 3rd generation

A
  • More narrow
  • Bactermia/septicemia, bone & joint, CNS, gynecological, intra-abdominal, lower respiratory, skin & skin structures infections, UTIs
  • ceftriaxone (Rocephin)
  • cefdinir (Omnicef)
  • cefixime (Suprax)
  • cefpodoxime (Vantin)
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15
Q

Carbapenems MOA

A

inhibit the growth of sensitive bacteria by inactivating enzymes located in the bacterial cell membrane

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16
Q

Carbapenems common pathogens covered

A

Gram neg, anaerobes, gram +

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17
Q

Carbapenems ADR & Monitoring

A
  • Hypersensitivity reaction, rash, headache, GI, seizures, drug fever, eosinophilia, thrombocytopenia, hepatitis, Clostridium difficile
  • Monitoring: hypersensitivity reactions, renal function, hepatic function, CBC
  • Of note: Cross sensitivity with PCN 50%, clinically relevant 1%. Seizure risk highest with imipenem-cilastatin (elderly, history of seizures, renal dysfxn)
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18
Q

Carbapenem drugs

A
  • Class of beta-lactam
  • Often reserved for more severe infections (last line)
  • etrapenem (Invanez)
  • cilastatinin/imipenem (Primaxin)
  • doripenem (Doribax)
  • meropenem (Merrem)
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19
Q

Monobactams-Aztreonam MOA

A

MOA: inhibit the growth of sensitive bacteria by inactivating enzymes located in the bacterial cell membrane

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20
Q

Monobactams-Aztreonam common pathogens covered

A

gram (-) – including Enterobactericeae and pseudomonas
-Monobactams used to treat: pyelonephritis, uncomplicated cystitis, lower RI, septicemia, skin infections, perotinitis, endometrosis

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21
Q

Monobactams - Aztreonam drugs

A
  • Azectam
  • Aztreonam
  • Cayston
  • Aztreonam inhalation
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22
Q

Monobactams - Aztreonam ADR & monitoring

A

rash, nausea, diarrhea, hepatitis, thrombocytopenia, Clostridium difficile

  • Monitor: Renal & hepatic
  • May be used in pts w/ PCN/cephalosporin allergy
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23
Q

Aminoglycosides MOA

A

moa: binding to aminoacyl site of 16S ribosomal RNA within 30S ribosomal subuit -> misreading of genetic codes, thus inhibits translocation

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24
Q

Aminoglycosides common pathogens covered

A

bactericidal against gram (-) aerobes

-also effective against staphylococci & myobacterium tuberculosis

25
Q

Aminoglycosides ADR & Monitoring

A
  • tubular necrosis & renal failure, vestibular and cochlear toxicity, neuromuscular blockade, vertigo, anemia, hypersensitivity
  • Monitoring: Renal function, serum drug concentration, serum calcium, magnesium, sodium. Monitor for nausea, vomiting, nystagmus, vertigo
  • ototoxicity may be irreversible
26
Q

Aminoglycoside drugs

A
  • generally broad spectum and potent
  • often used in combo
  • poor GI absorption so often given IV
  • tobramycin (Kitabis, Nebcin)
  • neomycin (Neo-Fradin)
  • amikacin (Amikin)
  • gentamicin (Garamycin)
27
Q

Lipopeptides-Daptomycin MOA

A

cyclic lipopeptide – calcium-dependent polarization of gram (+) cell membranes

28
Q

Lipopeptides-Daptomycin Common pathogens covered

A

Gram +, MRSA, VRE

29
Q

Lipopeptides-Daptomycin ADR & Monitoring

A

Monitoring: LFTS, muscle pain/weakness, CPK baseline & weekly – some may need more frequent monitoring. Discontinu if CPK > 10 ULN or if myopathy + CPK > 1000 IU/L

  • hepatotoxicity, CPK elevation, myopathy, diarrhea, eosinophilic pneumonia, Clostridium difficile
  • May want to stop statin therapy during daptomycin
30
Q

-Lipopeptides-Daptomycin Drugs

A 
Daptomycin 
Bacillomycin
surfactin
mycosubtillin
caspofungin
-used for complicated skin and skin structure infections, bacteremia
31
Q

Glycopeptides-Vancomycin MOA

A

MOA: inhibits bacterial cell wall synthesis

-Common pathogens covered gram +, MRSA

32
Q

Glycopeptides-vanco ADR & monitoring

A
  • ADR: Red man syndrome, phlebitis, renal dysfunction, neutropenia, leukopenia, eosinophilia, thrombocytopenia, drug fever
  • Monitoring: renal function, CBC, serum drug concentration
33
Q

Oxazolidinones-linezolid & tedizolid MOA

A

MOA: inhibit bacterial protein synthesis at 50S ribosome, suppress toxics such as Panton-Valentine leucocidin, alpha-hemolysin, and toxic shock syndrome toxin-1

34
Q

Oxazolidinones – linezolid and tedizolid: Common pathogens

A

bacteriostatic; gram (+) organisms

35
Q

Oxazolidinones – linezolid and tedizolid ADR & Monitoring

A

ADR: myelosuppression, peripheral neuropathy, optic neuropathy, blindness, lactic acidosis, diarrhea, nausea, serotonin syndrome, interstitial nephritis

  • Monitoring: serotonin syndrome, CBC with diff. With long-term therapy – visual acuity and other visual tests
  • Of note: myelosuppression associated with > 2 week therapy and is reversible
36
Q

Tetracyclines: doxycycline, tetracycline, minocycline, tigecycline, eravacycline, sarecycline, omadacycline
-MOA

A

Mechanism of action: inside of cell wall binds reversible to 30S ribosomal subunit – ultimately inhibiting protein synthesis producing a bacteriostatic effects

37
Q

Tetracyclines common pathogens covered

A

-gram (+) and gram (-), atypical pathogens

38
Q

Tetracyclines: ADR & Monitoring

A
  • GI upset, NVD, hepatoxicity, esophageal ulcerations, photosensitivity, azotemia, visual disturbances, vertigo, hyperpigmentation, deposition on teeth, hemolytic anemia, pseudotumor cerebri, pancreatitis, Clostridium difficile
  • Monitoring: CBC with diff, LFTs, renal function
  • Of note: doxycycline preferred with renal dysfunction, vestibular symptoms women > men. Do not use in pregnancy or in children
39
Q

Rifamycines-rifampin, rifabutin, rifapentine MOA

A

thought to inhibit bacterial DNA-dependent RNA polymerase

40
Q

Rifamycines-rifampin, rifabutin, rifapentine Common pathogens covered

A

mycobacterial infections, selective invasive staphylococcal infections

41
Q

Rifamycines-rifampin, rifabutin, rifapentine: ADR & Monitoring

A
  • Discolored urine, tears, contact lens, sweat, hepatotoxicity, GI upset, flu-like syndrome, hypersensitivity, thrombocytopenia, leukopenia, drug fever, interstitial nephritis
  • Monitoring: LFTs, bilirubin, renal fxn, CBC at baseline + q2weeks if patient is also receiving hepatoxic medications or if have impairment
42
Q

Macrolides-azithromycin, clarithromycin MOA

A

MOA: bind to 50S subunit of bacterial ribosomes – leading to inhibition of bacterial protein synthesis

43
Q

Macrolides-azithromycin, clarithromycin common pathogens covered

A

mycobacteria, gram (-), atypical, and some gram (+)

44
Q

Macrolides-azithromycin, clarithromycin: ADR & Monitoring

A

GI intolerance, prolonged QTc, cholestatic hepatitis, ototoxicity (reversible), TDP, rash, hypothermia, exacerbation of myasthenia gravis
Monitoring: LFTS, ECG if high risk

45
Q

lincomycin class: Clindamycin MOA

A

-binds to 50S ribosomal subunit of bacteria; disrupts bacterial protein synthesis, post-antibiotic effect. Generally thought to be bacteriostatic, but can be bactericidal with some organisms

46
Q

Bacteriostatic

A

-agent prevents the growth of bacteria

47
Q

Bacteriocidal

A

-Kills bacteria

48
Q

Clindamycin common pathogens covered

A

anaerobes, streptococcus, staphylococcus

49
Q

Clindamycin ADR & Monitoring

A
  • diarrhea, Clostridium difficile, nausea, vomiting, generalized rash, hypersensitivity
  • Monitoring: renal and liver function for prolonged therapy. Monitor for diarrhea – common cause of Cdiff colitis.
50
Q

Fluoroquinolones – besifloxacin, ciprofloxacin, levofloxacine, gatifloxacin, moxifloxacin, ofloxacin MOA

A

bactericidal – directly inhibit bacterial DNA synthesis

51
Q

Fluoroquinolones – besifloxacin, ciprofloxacin, levofloxacine, gatifloxacin, moxifloxacin, ofloxacin common pathogens covered

A

aerobes, gram (-), respiratory pathogens, some gram (+) organisms

52
Q

Fluoroquinolones – besifloxacin, ciprofloxacin, levofloxacine, gatifloxacin, moxifloxacin, ofloxacin: ADR & Monitoring

A
  • GI intolerance, headache, malaise, insomnia, QTc prolongation, tendon rupture, peripheral neuropathy, crystalluria, seizure, interstitial nephritis, SJS, allergic pneumonitis, Clostridium difficile
  • Monitoring: renal function, confusions, hallucinations, tremor
  • Of note: tendon rupture more frequently seen in elderly & kidney, heart, lung transplant patients, and concurrent use of corticosteroids
53
Q

Sulfonamides & Trimethoprim MOA

A
  • SMX – competes with PABA to inhibit dihydrofolic acid (stops converstion to tetrahydrofolic acid).
  • TMP binds to bacterial dihydrofolate reductase, prevents formation of tetrahydrofolic acid. This is done preferentially in bacteria vs human. In turn, this inhibits DNA synthesis.
54
Q

Sulfonamides & Trimethoprim: Common pathogens covered

A

gram (+), gram (-). Community acquired MRSA, Pnemocystis jirovecii, nocardia

55
Q

Sulfonamides & Trimethoprim: ADR & Monitoring

A
  • GI intolerance, rash, hyperkalemia, bone marrow suppression, serum sickness, hepatitis, photosensitivity, crystalluria with azotemia, methemoglobinemia, urolithiasis, SJ, TEN, aseptic meningitis, pancreatitis, interstitial nephritis, Sweet syndrome, neurologic toxicity
  • Monitoring: hypersensitivity reactions, rash, CBC, renal function, hepatic function, potassium, serum glucose
  • HIV-infected patients are increased risk for ADR
56
Q

Sulfonamide drugs

A
  • Bactrim
  • Cotrim
  • Septra
  • Erythromycin/sulfisoxazole
57
Q

Metronidazole MOA

A

MOA: produces free radicals that are toxic to microbe through a 4-step process

58
Q

Metronidazole common pathogens covered

A

anaerobes, protozoa

59
Q

Metronidazole ADR & Monitoring

A
  • GI intolerance, headache, metallic taste, dark urine, peripheral neuropathy, disulfiram-like reactions with alcohol, insomnia, stomatitis, aseptic meningitis, dysarthria
  • Monitoring: Liver function, mental and neurologic status
  • Of note: peripheral neuropathy is reversible, associated with long-term treatment

Pharmacology (24 decks)

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