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Mcrbly nd Pblc Hlth > Antimicrobial Therapy > Flashcards

Antimicrobial Therapy Flashcards

1
Q

Combinations

A
  • Additive
  • Synergistic
  • Antagonistic
  • Potentiation
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2
Q

Penicillin + Aminoglycoside

A

Synergistic

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3
Q

Penicillin + Tetracycline

A

Antagonistic

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4
Q

Penicillin + Clavulanic Acid

A

Potentiation

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5
Q

Cell Wall Synthesis Inhibitors

— ALL cell wall inhibitors are BACTERICIDAL

A 
• Penicillin 
• Cephalosporins
• Other Beta Lactams 
 - Monobactams
 - Carbapenems
 - Glycopeptide
 - Bacitracin
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6
Q
  • MOA: X Transpeptidation
  • Alexander Fleming
  • Penicillin — Penicilloic Acid
  • Bactericidal
A

Penicillin

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7
Q

Stability of Penicillin

A
  • Crystalline/ powder form
  • Solutions/ Suspension must be freshly prepared
    • Suspensions 14 days — ✔️ ref
      7 days — ✖️ ref
  • Amber colored bottles
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8
Q

Special precautions for Penicillins

A

Cross-reactivity w/ Cephalosporins

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9
Q

Drug-Drug Interactions of Penicillin

A

• Ampicillin + Allopurinol = Rash
• Penicillin + B blocker = Hypersensitivity
• Penicillin + Probenecid = ⬆️ Penicillin levels
— blocks the tubular secretion of Penicillin

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10
Q

Pharmacokinetics of Penicillin

A
  • Absorption varies greatly
  • Food retards absorption (except Amoxicillin)
  • Distribution: Poor penetration
  • Excretion: Kidney
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15
Q

Natural Penicillins

A
  • Pen G – acid labile

* Pen V – acid stable

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16
Q

Beta lactamase resistant

— narrow spectrum

A
  • Methicillin
  • Oxacillin
  • Cloxacillin
  • Nafcillin
  • Dicloxacillin
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17
Q

Extended Spectrum

A
  • Aminopenicillins
  • Carboxypenicillins — Antipseudomonal
  • Ureidopenicillins — Antipseudomonal
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18
Q

Aminopenicillins

A
  • Ampicillin
  • Amoxicillin
  • Bacampicillin
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19
Q

Carboxypenicillin

A
  • Carbenicillin

* Ticarcillin

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20
Q

Ureidopenicillin

A
  • Mezlocillin
  • Azlocillin
  • Piperacillin
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21
Q
  • G (+), G (-), anaerobes, spirochetes
  • Aqueous Pen G
  • Procaine Pen G
  • Benzathine Pen G
A

Pen G

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22
Q

Prophylaxis of rheumatic fever and tx of syphilis

A

Pen G

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23
Q
  • Phenoxymethyl Penicillin

- Oral — Vivig

A

Pen V

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24
Q
  • X active against G (-)

- Antistaphylococcal

A

Beta lactamase resistant

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25
Q

Special precautions of Cephalosporins

A
  • Pseudomembranous colitis
  • Coagulation abnormality
  • Nephrotoxicity
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26
Q

Pharmacokinetics of Cephalosporins

A
  • Absorbed in GIT

- Delayed by food

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27
Q

Drug-Drug Interactions of Cephalosporins

A
  • 2nd/3rd Gen + Ethanol= Disulfiram Like effect
    • Aminoglycosides = severe nephrotoxicity
    • Anticoagulants = bleeding
    • Probencid = ⬆️ T 1/2
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28
Q

1st Gen

A

“Ceph-“

— EXCEPTION: Cefazolin, Cefalexin, Cefadroxil, Cefradine

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29
Q

2nd Gen

A

“Cef-“
— ✖️ end with “-one” and “-ime”
— EXCEPT: Cefuroxime
— Alternatively, most 2nd gen are “Cef” + vowel

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30
Q

3rd Gen

A

“Cef-“
— Most end with”-one” and “-ime”
— EXCEPT: Cefditoren, Cefdinir, Moxalactam, Ceftibuten
—Most 3rd gen are “Cef” + consonant

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31
Q

3rd Gen can cross BBB except:

A
  • Ceftibuten
  • Cefixime
  • Cefpodoxime
  • Cefoperazone
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32
Q

4th Gen

A

• Cefipime
• Cefpirome
— associate w/ “pi”

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33
Q

Other Beta Lactams

A
  • Monobactams
  • Carbapenenem
  • Glycopeptides
  • Bacitracin
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34
Q
  • Reserved for serious infections
  • G (-)
  • Resistant to beta lactamase
A

Monobactams

— Aztreonam

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35
Q

Carbapenems

A
  • Imipenem
  • Meropenem
  • Ertapenem
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36
Q
  • Strep. orientalis
  • ✔️ MRSA
  • If VRSA — Daptomycin or Linezolid
  • AE: Red Man Syndrome
A

Vancomycin

Glycopeptides

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37
Q
  • G(+)
  • Nephrotoxic
  • Topical only
A

Bacitracin

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38
Q

Protein Synthesis Inhibitors

“Buy AT 30 CELLS for 50”

A
  • Tetracyclins
  • Aminoglycosides
  • Chloramphenicol
  • Macrolides
  • Limcosamides
  • Linezolid
  • Streptogrammins
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39
Q
  • MOA: ✖️ 30s
  • Absorption: Impaired by food
    EXCEPT: Doxycycline and Minocycline
  • Excretion: Kidney
  • Indications: Cholera, Mycoplasma, Chlamydia, Rickettsia,
    Demeclocycline — SIADH
A

Tetracyclines

40
Q

Warnings for Tetracyclines

A
  • Photosensitivity, esp. Demeclocycline
  • Hepatotoxic
  • Nephrotoxic, except: Doxycycline — excreted in the urine
  • Yellow discoloration in teeth, bone deformities in children
41
Q
  • MOA: ✖️ 30s
  • G (-)
  • Bactericidal
  • ✖️anaerobes
  • ✖️ absorbed in GIT
A

Aminoglycosides

42
Q

AE of Aminoglycosides

A
  • Ototoxic — Neomycin, Amikacin, Kanamycin
  • Nephrotoxic — Neomycin, Gentamicin, Tobramycin
  • Vestibulotoxic — Streptomycin, Gentamicin
43
Q

Interactions of Aminoglycosides

A
    • Cephalosporins = Nephrotoxic

* + NMJ Blockers = Paralysis

44
Q
  • MOA: ✖️ 50s
  • Bacteriostatic
  • DOC: Typhoid
A

Chloramphenicol

45
Q

AE of Chloramphenicol

A
  • Grey baby syndrome (Neonates)
  • Bone marrow suppression (Dose-related)
  • Aplastic anemia (non-dose related)
  • Avoid in G6PD deficient patient (hemolytic anemia)
46
Q
  • MOA: ✖️ 50s
  • G (-), G (+), anaerobes
  • inhibit CYP450 enzymes
  • most common AE: GI disturbances
A

Macrolides

47
Q
  • isolated from soil in IloIlo
  • Estolate salt (best preparation)
  • DOC: CAP, Chlamydia, Corynebacterium
A

Erythromycin/ Ilothycin

48
Q
  • for Toxoplasma and Mycobacteria

- ✔️ Eythromycin-resistant Staph and Strep

A

Clarithromycin

49
Q
  • excreted in the bile

- ✔️ renally impaired px

A

Azithromycin

50
Q
  • MOA: ✖️ 50s
A

Lincosamides

51
Q
  • Streptomyces lincolnensis

- similar activity to macrolides

A

Lincomycin

52
Q
  • AE: Pseudomembranous colitis
A

Clindamycin

53
Q
  • MOA: ✖️ 50s

- For VRSA, VREF

A

Linezolid

54
Q
  • MOA: ✖️ 50s
  • For VREF
  • Synercid = Quinopristine + Dalfopristin
A

Streptogrammins

55
Q

Nucleic Acid Synthesis Inhibitors

A
  • Sulfonamides
  • Trimethoprim
  • Co-trimoxazole
  • Quinolones
56
Q
  • MOA: ✖️ dihydropteroate synthesis
  • similar structure to PABA
  • indication: PCP, Toxoplasma
A

Sulfonamides

57
Q

Forms of Sulfonamides

A
  • Oral absorbable - Sulfisoxazole
  • Oral nonabsorbable - Sulfasalazine
  • Topical - Silver Sulfasalazine
58
Q
  • MOA: ✖️ dihydrofolate reductase

- AE: Megaloblastic anemia (macrocystic)

A

Trimethoprim

59
Q
  • Bactrim
  • Trimethoprim + Sulfamethoxazole
  • Indications: UTI, PCP, Pyrlonephritis
  • ✖️ Pregnancy
A

Co-trimoxazole

60
Q
  • MOA: ✖️ DNA gyrase
  • Bactericidal
  • Well absorbed orally
  • Indications: UTI, PCP, G (-) infections
  • AE: tendonitis
A

Quinolones

61
Q

1st Gen

A

Nalidixic Acid

62
Q

2nd Gen

A
  • Ciprofloxacin
  • Ofloxacin
  • Norfooxacin
63
Q

3rd Gen

A
  • Levofloxacin

- Sparfloxacin — Active for Strep.

64
Q

4th Gen

A
  • Moxifloxacin

- Travafloxacin

65
Q

Anaerobic Inhibitors

A
  • Metronidazole

* Clindamycin

66
Q
  • MOA: In aerobes: converted to free radicals
  • Antiprotozoal: Trichomonas, Entamoeba, Giardiasis
  • Antibacterial: PUD, Pseudomembranous colitis — DOC
A

Metronidazole

67
Q

Drugs for Mycobacteria

A
  • Drugs for TB/ Anti Koch’s Drugs

- Drugs for Leprosy/ Anti Hansen Drugs

68
Q

Drugs for TB/ Anti Koch’s Drugs

A
  • Isoniazid
  • Rifampicin
  • Pyrazinamide
  • Ethambutol
  • Streptomycin
69
Q
  • Tuberculocidal — Rapidly dividing
  • MOA: ✖️ mycolic acid synthesis
  • for intracellular, extracellular bacteria
  • penetrates all body fluids
  • AE: peripheral neuropathy, hepatitis
A

Isoniazid

70
Q
  • Tuberculocidal
  • MOA: ✖️ RNA synthesis
  • Active for slow dividing bacteria
  • Hepatic enzyme inducer
  • from Streptomyces mediterranei
  • AE: red discoloration of body fluids
A

Rifampicin

71
Q
  • Tuberculocidal
  • MOA: ✖️ ETC in mycobacteria
  • good penetration to meninges
  • ✔️ TB meningitis
A

Pyrazinamide

72
Q

AE for Pyrazinamide

A
  • Hepatotoxicity
  • Gout
  • Vertigo and Hearing loss
73
Q
  • Tuberculostatic
  • ✖️ Arabinogalactan synthesis (cell wall component)
  • ✖️ penetrate meninges
  • AE: Optic neuritis
A

Ethambutol

74
Q
  • only parenteral 1st line drug (poor GI absorption)

- DOC: Tularemia and infections of bubonic plague

A

Streptomycin

75
Q

Inactivated by beta lactamase

A

Extended Spectrum

76
Q
  • Highest BA

- Prodrug: Bacampicillin

A

Ampicillin

77
Q
  • Antipseudomonal
  • ✔️ for serious infections
  • Tazocin = Piperacillin + Tazobactam
A

Carboxypenicillin and Ureidopenicillin

78
Q
  • More stable against Beta lactamase
  • X active Listeria & Enterococcus
  • Bactericidal
  • Pregnancy Category: B
A

Cephalosporins

79
Q

1st Line — TB

TB — MDRTB

A

RIPES

HRZE

80
Q

2nd Line — TB

MDRTB — XDRTB

A
  • Ethionamide
  • Aminoglycosides
  • Fluoroquinolones
  • Cycloserine
  • Linezolid
  • P-aminosalicylic acid
81
Q
  • Usually 2 months
  • Use Tuberculocidal, INH, Rifampicin, PRZA
  • Kill actively and rapidly dividing bacteria (large population killed)
A

First Phase/ Intensive Phase

82
Q
  • 4 months

- aim to kill slowly dividing bacteria

A

Second/ Maintenance Phase

83
Q

Tx failure

A

If px is still (+) after 5 months of tx

84
Q
  • min. of 9 months tx
  • intensive: 2-3 months
  • maintenance: 7-9 months
A

Extrapulmonary TB

85
Q

Drugs for Leprosy/ Anti Hansen Drugs

A
  • Dapsone
  • Rifampicin
  • Clofazimine
86
Q
  • Structurally related to sulfonamides
  • MOA: ✖️ Folic acid synthesis
  • Indications: PCP, intermediate & Tuberculoid Leprosy
A

Dapsone

87
Q
  • Sulfone-resistent therapy
  • Fat soluble
  • AE: skin discoloration
A

Clofazimine

88
Q
  • Tx: 6 months
    Dapsone
    Rifampicin
A

Tuberculoid

89
Q
  • Tx: 24 months
    Dapsone
    Rifampicin
    Clofazimine
A

Lepromatous

Mcrbly nd Pblc Hlth (10 decks)

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