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Pharm Practice 4 > Antimicrobial Therapy > Flashcards

Antimicrobial Therapy Flashcards

1
Q

Cocci arrangements

A

clusters, chains and pairs

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2
Q

Bacilli arrangement

A

rods

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3
Q

Spirochetes arrangement

A

coiled

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4
Q

Bacterial cell wall composition

A

peptidoglycan

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5
Q

Gram (+) vs Gram (-) bacteria

A

Gram (+): thick peptidoglycan layer, many have teichoic acid, no periplasmic layer, no LPS, no outer membrane, primarily produces exotoxins, has flagella, tough

Gram (-): thin peptidoglycan layer, no teichoic acid, outer membrane is present, periplasmic space, has LPS, has flagella, produces endotoxins, not very tough

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6
Q

Gram (+) organisms

A

Staphylococcus- cocci in clusters
streptococcus- coccus in chains
enterococcus-cocci in chains
listeria- rods

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7
Q

Gram (-) organisms

A

Neisseria- cocci

Rod: escherichia, salmonella, klebsiella, pseudomonas, proteus, haemophilus, legionella

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8
Q

Anaerobic organisms

A

clostridium, bacteroides, peptostreptococcus

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9
Q

Atypical organisms

A

chlamydiae, mycoplasmas, rickettsiae

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10
Q

Common organisms found on SKIN

A

staphylococcus aureus and streptococcus pneumoniae

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11
Q

Common organisms found in the ENTERIC (gut)

A

escherichia coli, salmonella, klebsiella, proteus

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12
Q

Common organisms found in the RESPIRATORY tract

A

haemophilus influenza, legionella

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13
Q

Common organisms found in the CNS

A

listeria, neisseria, haemophilus

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14
Q

Common organisms found in the HEART

A

staphylococci, streptococci, enterococci

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15
Q

Common organisms found in the GENITOURINARY tract

A

neisseria gonorrhea, escherichia coli, proteus

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16
Q

Time dependent

A

optimal effect when the antibiotic concentration remains above the MIC in any one duration of the dosing interval

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17
Q

Concentration dependent

A

optimal effect when concentrations are appreciably above the MIC for a given organism (up to a specific level)

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18
Q

Bacteriostatic

A

INHIBITION of bacterial growth

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19
Q

Bacteriocidal

A

KILLING of the bacteria

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20
Q

Beta-lactams

A

the beta-lactam ring inhibits bacterial cell wall synthesis
bacteriCIDAL
time dependent killing

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21
Q

Penicillins

A

Penicillin VK
Amoxicillin
Dicloxacillin
Amoxicillin-Clavulanate

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22
Q

Penicillin VK

A

Veetids
oral- tab and powder for reconstitution
kids: 25-75 mg/kg/day in divided doses q6-8h
adults: 125-500mg PO q6-8h
covers mostly gram (+) (enterococci and streptococci)
indications: pharyngitis, otitis media, skin/soft tissue infections, rheumatic fever
AEs: melanoglossia, mild GI effects: n/v/d
time dependent and bactericidal
take on empty stomach 1 hr before or 2 hrs after meals

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23
Q

Amoxicillin

A

Amoxil
Oral- cap and powder for recostitution
kids: 25-50mg/kg/day in divided doses q8h
adults: 250-500mg PO q8-12h
covers gram (+) and some gram (-)
indications: pharyngitic, lower resp. tract infections, endocarditis prophylaxis, ENT/skin and soft tissue infections, animal bites
AEs: n/v/d (take w/ food)
time dependent and bactericidal
Pearls: give ATC, shake suspension well - can mix w/ formula, milk, fruit juice, water, ginger ale, cold drinks

24
Q

Amoxicillin-Clavulanate

A

Augmentin
Oral: Tabs and susp.
adults: 500mg q8-12h or 875mg q12h or 2g q12h
kids (<40kg): 20-45mg/kg/day in divided doses bid-tid
gram(+) and gram(-)
indications: sinusitis, otitis media, lower resp. tract infections, community acquired pneumonia, UTI, bite wounds
AEs: diarrhea, N/V, abdominal distress, hepatic dysfunction
Pearls: adjust in renal dysfunction, give ATC,
take w/ food to increase absorption and decrease stomach upset

25
Q

Dicloxacillin

A

oral: capsule
125-500mg q6h
Only covers staphylococcus epidermis and aureus (MSSE and MSSA)
Indications: skin/soft tissue infections, bite wounds, impetigo
AEs: abdominal pain, diarrhea, nausea
Pearls: take 1 hr before or 2hrs after meals w/ at least 120ml of water, take ATC to prevent variations in peak and trough serum levels,
Drug interaction: warfarin (lowers INR)

26
Q

Cephalosporins

A

4 generations
some cross sensitivity w/ pcn allergy
none of them cover enterococci

27
Q

Cephalexin

A

Keflex- 1st gen
Oral: cap and susp. for recon
Adult: 250-1000mg q6h or 500mg q12h (max 4g/day)
Kids: 25-100mg/kg/day in divided doses q6-8h (max: 4g/day)
Covers streptococci and staphylococcus aureus w/ some gram (-) coverage
Indications: impetigo, skin/soft tissue infections, pharyngitis, UTI, otitis media
AEs: ab. pain, diarrhea, dyspepsia
Pearls: dose adjust-renal impairment, give w/o regard to food but if GI distress- take w/ food, give ATC, associated w/ elevated INR
drug interaction: metformin (increase metformin serum conc.)

28
Q

Cefaclor

A

Ceclor- 2nd gen.
Oral: tab, cap, susp for recon.
Adult: 25-500mg q8h or 500mg q12h for ER
Kids: 20-40mg/kg/day divided q8-12h
Covers streptococci and staphylococcus aureus w/ expanded Gram (-) coverage and anaerobic coverage
Indications: bronchitis, otitis media
AEs: diarrhea (use caution in hx of GI diseases), increase in transaminase/LFTs (monitor if on long term tx)
Pearls: dose adjust in renal impairment, give ATC, take w/ or w/o food, shake susp. well
ER tabs: don’t chew/crush/split and give w/ or w/in 1 hr of food

29
Q

Ceftriaxone

A

Rocephin- 3rd gen.
IV or IM (not orally)
Adult: 1-2g q12-24h
Kids: 50-100mg/kg/day in 1-2 divided doses q12-24h
Covers gram (+) and gram (-) orgs
Indications: endocarditis, gonorrhea, GI infections, meningitis
AEs: diarrhea, skin tightness and warm sensation at injection site (IM), pancreatitis
Contraindicated in hyperbilirubinemic neonates (<28 days old) and/or contraindicated w/ IV calcium
Concurrent renal/hepatic impairment: no more than 2g/day

30
Q

Cefepime

A

Maxipime-4th gen.
IV
Adults: 1-2g q8-12h
Kids: 50mg/kg/dose q8-12h
Covers gram (+) and gram (-) w/ expanded coverage of orgs w/ multi-drug resistance patterns
Indications: intra-abdominal infections, pneumonia, UTI, meningitis
AEs: positive direct Coombs test, transaminitis/increase LFTs, hypophosphatemia, neurotoxicity
Pearls: dose adjust in renal impairment

31
Q

Protein Synthesis Inhibitors- drug classes

A

aminoglycosides
tetracycines
macrolides
clindamycin

32
Q

Aminoglycosides

A

Binds 30S ribosomal subunit
bactericidal, conc. dependent
Gentamycin, Tobramycin, Neomycin

33
Q

Gentamycin

A

IV or IM
2-5mg/kg/day divided doses q8h
Covers mostly gram (-)
Indications: endocarditis, meningitis, intra-abdominal infections, sepsis/septic shock, synergy w/ other antibiotics
AEs: nephrotoxicity, neurotoxicity- ototoxicity, neuromuscular toxicity
Pearls: TDM required, avoid in pregnancy, dose adjust in renal impairment

34
Q

Tetracycline

A

Binds to 30S ribosome subunit
bacteriostatic and time dependent
Doxycycline, minocycline, demeclocycline

35
Q

Doxycycline

A

Oral: IR and ER formulations
1000-200mg/day in 1-2 divided doses
Covers some gram (+) and gram (-), some anaerobics, atypical orgs.
Indications: pneumonia, Rocky Mountain Spotted fever, Chlamydia, Lyme disease
AEs: GI inflammation/ulceration, intracranial hypertension, photosensitivity, tissue hyperpigmentation, hepatotoxicity
Pearls: things that can decrease serum conc: chronic alcohol use, taking w/ high-fat meal/milk, taking w/ iron/calcium
may cause tissue hyperpigmentation/tooth enamel hypoplasia or permanent tooth discoloration when used during tooth development (last half of pregnancy, infancy, kids <8)
**good option for people that can’t take azithromycin

36
Q

Macrolides

A

bind 50s ribosome subunit
Bacteriostatic
time dependent or conc. dependent
azithromycin, erythromycin, clarithromycin, fidaxomicin

37
Q

Azithromycin

A

Zithromax
oral
1-2g single dose (chlamydia), 500mg diaily, or 500mg on day 1 then 250mg days 2-5
Covers some gram (+) and gram (-) and atypical orgs
Indications: pneumonia, sinusitis, chlamydia, H. pylori infections, pharyngitis, pelvic inflammatory disease
Pearls: inhibits P-gp - avoid w/ amiodarone
AEs: loose stool, vomiting, nausea, diarrhea, QT-prolongation

38
Q

Erythromycin

A

E.E.S 400 or Ery-Tab

Time dependent

39
Q

Clarithromycin

A

Biaxin

40
Q

Fidaxomicin

A

Dificid

41
Q

Clindamycin info

A

Lincosamide
binds to 50S ribosomal subunit
bacteriostatic
time dependent

42
Q

Clindamycin

A

Cleocin
oral and IV
Adults: 150-450mg PO q6h (600-2700mg/day in 2-4 divided doses)
Kids: 8-40mg/kg/day PO in 3-4 divided doses (20-40mg/kg/day in 3-4 divided doses)
Covers: expanded gram (+), anaerobic orgs
Indications: pneumonia, otitis media, bone/joint infections, intra-abdominal infections, lower resp. tract infections, skin/soft tissue infections
AEs: diarrhea, metallic taste (IV), black box warning: colitis
Pearls: use w/ caution in GI disease/mod-severe hepatic impairment

43
Q

Metronidazole info

A

nitroimidazole pro-drug
bactericidal
conc. dependent
Effects org’s DNA: disrupts structure inhibiting replication

44
Q

Metronidazole

A

Flagyl
oral and IV
250-750mg PO/IV q8h
Covers anaerobic orgs and parasites
Indications: amebiasis, bacterial vaginosis, intra-abdominal infections, trichomoniasis, giardiasis, C.diff associated diarrhea
AEs: HA, nausea, metallic taste, CNS related effects
black box warning: carcinogenic in mice- avoid unnecessary use
Pearls: IV form contains sodium, avoid alcohol during treatment and at least 3 days after- disulfiram-like reaction, dose adjust in severe hepatic impairment
Contraindicated in 1st trimester
Drug-drug interactions: warfarin (increased INR) lopinavir (inhibits metabolism and contains alcohol)

45
Q

Sulfamethoxazole and Trimethoprim MOA

A

Sulfamethoxazole- inhibits conversion of PABA to dihydropteroic acid by inhibiting dihydropteroate synthase
Trimethoprim: prevents reduction of dihydrofolic acid to tetrahydrofolic acid by inhibiting dihydrofolate reductase
Combo is bactericidal
concentration dependent

46
Q

Sulfamethoxazole and Trimethoprim

A

Bactrim
PO and IV
Bactrim DS: 160mg TMP/800mg SMX tabs - 1 tab q12h
Bactrim SS: 80mg TMZ/400mg SMX - 2 tabs q12h
IV: 80mg TMP/400mg SMX
Indications: UTI, pneuomcystis carinii jirovecii (PJP), nosocomial infections, otitis media
Covers: staphylococci and gram (-) orgs
AEs: n/v (take w/ food), rise in SCr, hyponatremia, crystaluria (drink lots of water), hyperkalemia (TMP looks like amiloride- K+ sparing diuretic)
Pearls: SMX metabolized by CYP2C8, TMP metabolized by CYP2C9 - drug interactions (warfarin, oral antidiabetic agents), avoid in 1st trimester, renal impairment, avoid in G6PD deficiency/sulfonamide allergy (skin rash/pruritus)

47
Q

Nitrofurantoin MOA

A

activated by enzymatic reduction
damages bacterial DNA
Bactericidal
Conc. dependent

48
Q

Nitrofurantoin

A

Macrobid: 100mg bid
Macrodantin: 50-100mg q6h
Covers: gram (+) and gram (-)
Indications: UTI
AEs: brown urine, optic neuritis and peripheral neuropathy, pulmonary toxicity, hepatic reactions
Pearls: take w/ food, avoid in G6PD deficiency, interacts w/ Mg2+ lowering effectiveness
Contraindications: pregnant women at term, CrCl<60 (relative), hx of cholestatic jaundice/hepatic dysfunction

49
Q

Fluoroquinolones info

A 
inhibits DNA gyrase and topoisomerase IV
bactericidal
Conc. dependent
ciprofloxacin (Cipro)
levofloxacin (Levaquin)
moxifloxacin (Avelox)
50
Q

Fluoroquinolones

A

Broad spectrum coverage: minimal gram (+), covers gram (-), atypical orgs (levofloxacin and moxifloxacin better resp. covering agent and moxifloxacin has expanded coverage)
Indications: UTI, endocarditis, prostatitis, pneumonia, STIs, GI/abdominal infections, resp. tract, bone, joint, soft tissue infections
AEs: GI upset (take w/ food), CNS effects (elderly), QT prolongation, hepatotoxicity, tendon rupture( >60, transplant pt, concomitant steroids), hypoglycemia, crystaluria (drink lots of water), photosensitivity
Pearls: avoid antacids/ iron/zinc (tri and divalent cations) decreases effectiveness- take 2hrs before or 6hrs after the drug
Black box warning: reserve for pts have no alternative tx options for acute exacerbation of chronic bronchitis, acute sinusitis, acute uncomplicated cystitis (UTI)

51
Q

Ciprofloxacin

A 
Cipro
PO: 500-750mg q12h
IV: 400mg q12h
Pearls: dose adjust in renal impairment
drug-drug interactions: Substrate of OAT3, P-gp/ABCB1, Inhibits CYP1A2 (moderate), CYP3A4 (weak)
52
Q

Levofloxacin

A

Levaquin
PO or IV: 250-750mg q24h
dose adjust in renal impairment, minimal hepatic metabolism (fewer interactions)

53
Q

Moxifloxacin

A 
Avelox
PO or IV: 400mg q24h
not metabolized by CYP450 isoenzymes
highest risk of QT prolongation
**not used for UTI**
54
Q

Bacteriostatic antibiotics

A

Tetracycline
Macrolides
Clindamycin

55
Q

Bactericidal antibiotics

A 
Beta-lactams: penicillins, cephalosporins
Aminoglycosides
Metronidazole
Bactrim
Nitrofurantoin
Fluoroquinolones
56
Q

Concentration dependent antibiotics

A 
Aminoglycosides
Macrolides
Metronidazole
Bactrim
Nitrofurantoin
Fluoroquinolones
57
Q

Time dependent antibiotics

A

Beta-lactams: penicillins, cephalosporins
Tetracycline
Macrolides
Clindamycin

Pharm Practice 4 (8 decks)

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