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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
Dicloxacillin
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
Cephalosporins
4 generations some cross sensitivity w/ pcn allergy none of them cover enterococci
27
Cephalexin
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
Cefaclor
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
Ceftriaxone
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
Cefepime
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
Protein Synthesis Inhibitors- drug classes
aminoglycosides tetracycines macrolides clindamycin
32
Aminoglycosides
Binds 30S ribosomal subunit bactericidal, conc. dependent Gentamycin, Tobramycin, Neomycin
33
Gentamycin
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
Tetracycline
Binds to 30S ribosome subunit bacteriostatic and time dependent Doxycycline, minocycline, demeclocycline
35
Doxycycline
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
Macrolides
bind 50s ribosome subunit Bacteriostatic time dependent or conc. dependent azithromycin, erythromycin, clarithromycin, fidaxomicin
37
Azithromycin
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
Erythromycin
E.E.S 400 or Ery-Tab | Time dependent
39
Clarithromycin
Biaxin
40
Fidaxomicin
Dificid
41
Clindamycin info
Lincosamide binds to 50S ribosomal subunit bacteriostatic time dependent
42
Clindamycin
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
Metronidazole info
nitroimidazole pro-drug bactericidal conc. dependent Effects org's DNA: disrupts structure inhibiting replication
44
Metronidazole
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
Sulfamethoxazole and Trimethoprim MOA
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
Sulfamethoxazole and Trimethoprim
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
Nitrofurantoin MOA
activated by enzymatic reduction damages bacterial DNA Bactericidal Conc. dependent
48
Nitrofurantoin
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
Fluoroquinolones info
``` inhibits DNA gyrase and topoisomerase IV bactericidal Conc. dependent ciprofloxacin (Cipro) levofloxacin (Levaquin) moxifloxacin (Avelox) ```
50
Fluoroquinolones
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
Ciprofloxacin
``` 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
Levofloxacin
Levaquin PO or IV: 250-750mg q24h dose adjust in renal impairment, minimal hepatic metabolism (fewer interactions)
53
Moxifloxacin
``` Avelox PO or IV: 400mg q24h not metabolized by CYP450 isoenzymes highest risk of QT prolongation **not used for UTI** ```
54
Bacteriostatic antibiotics
Tetracycline Macrolides Clindamycin
55
Bactericidal antibiotics
``` Beta-lactams: penicillins, cephalosporins Aminoglycosides Metronidazole Bactrim Nitrofurantoin Fluoroquinolones ```
56
Concentration dependent antibiotics
``` Aminoglycosides Macrolides Metronidazole Bactrim Nitrofurantoin Fluoroquinolones ```
57
Time dependent antibiotics
Beta-lactams: penicillins, cephalosporins Tetracycline Macrolides Clindamycin

Pharm Practice 4 (8 decks)

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