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antimicrobials Flashcards

1
Q

bacteriostatic vs bacteriocidal

A

bacteriostatic: stops bacteria from reproducing. Bactericidal: kills bacteria

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2
Q

MIC vs MBC

A

Minimum inhibitory concentration: concentration to stop growth. Minimum bactericidal concentration: concentration which kills 99%

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3
Q

List the cell wall synthesis inhibitors

A

beta lactams (penicillins, cephalosporins, carbapenems, monobactams), vancomycin, bacitracin, and cycloserine

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4
Q

PenicillinsMOA, excretion and adverse rxns

A

Inhibit cell wall synthesis (bactericidal). Renal excretion. Adverse rxn: anaphylaxis type I, rash type III and convulsions (high dose)

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5
Q

Penicillin G and V: route and spectrum/uses

A

Pen G: IV/ IM (poor oral). Pen V: good PO. Both: gram +/- cocci, gram + bacilli, most anaerobes

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6
Q

List the penicillinase-resistant penicillins

A

Methicillin, oxacillin (dicloxacillin, cloxacillin)

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7
Q

List the extended spectrum penicillins

A

amoxicillin, ampicillin

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8
Q

list the antipseudomonal penicillins

A

piperacillin (ticarcillin, mezlocillin, carbenicillin)

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9
Q

List the penicillin + beta-lactamase inhibitor combos

A

Amoxicillin/ clavulanate, piperacillin/ tazobactam, (ampicillin/sulbactam, ticarcillin/clavulanate)

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10
Q

penicillinase resistant penicillins spectrum/uses

A

Beta-lactamase producing Staph aureus

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11
Q

Extended spectrum penicillins uses

A

gram neg enterobacteria (H flu, e coli)

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12
Q

antipseudomonal penicillins uses

A

pseudomonas, bacteroides

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13
Q

List first generation cephalosporins

A

cephalexin, cefazolin (cephradine, cefadroxil, cephapirin)

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14
Q

list 2nd generation cephalosporins

A

cefuroxime, cefaclor (cefotetan, cefoxitin, cefprozil, lorcarbef, cefmetazole, cefonicid)

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15
Q

List 3rd generation cephalosporins

A

ceftriaxone, ceftazidime, cefdinir, cefepime (cefotaxime, cefoperazone, cefixime, cefpodoxime, ceftizoxim)

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16
Q

cephalosporins MOA, adverse rxns

A

Inhibit cell wall synthesis (bactericidal). Allergy less severe than penicillins

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17
Q

first gen cephalosporins uses

A

Gram pos cocci, gram neg cocci and rods (e coli, klebsiella proteus)

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18
Q

Second gen cephalosporins uses

A

gram + cocci, gram - cocci/rods, extended gram - (H flu and enterobacter) and some anaerobes

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19
Q

third gen cephalosporins uses

A

More gram -, less gram +, plus moderate antipseudomonal. Also distributes well in CSF

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20
Q

List carbapenems

A

imipenem/cilastatin, ertapenem (meropenem)

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21
Q

list monobactams

A

aztreonam

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22
Q

Monobactams uses

A

aerobic gram neg only

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23
Q

Carbapenems uses

A

wide spectrum- used for resistant organisms and cephalosporinases

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24
Q

Vancomycin uses

A

narrow gram pos cocci

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25
List the protein synthesis inhibitors
aminoglycosidea, macrolides, tetracyclines, chloramphenical, clindamycin, streptogramins and linezolid
26
List aminoglycosides
tobramycin, gentamicin (neomycin, streptomycin, netilmicin, paromomycin)
27
List tetracyclines
tetracycline, doxycycline, minocycline
28
List the macrolides
erythromycin, clarithromycin, azithromycin
29
aminoglycosides MOA, route, adverse toxicity
Inhibits 30s ribosomal subunit (bactericidal). IV/IM (poor oral). High toxicity- vestibular and auditory toxicity, nephrotoxicity
30
aminoglycosides uses
gram negative aerobes (e coli, pseudomonas). Limited gram pos. TB
31
tetracycline MOA, adverse rxns
Inhibits 30S ribosomal subunit (bacteriostatic). Causes abnormal bone and tooth development (don’t use if <8 yrs), superinfections (fungal)
32
Tetracycline uses
Broad spectrum gram pos and neg. Rickettsia, chlamydia, mycoplasma, spirochetes
33
Macrolides MOA, adverse rxns
Inhibits 50S ribosomal subunit (bacteriostatic/cidal). Drug interactions due to inhibition of P450.
34
Macrolides uses
gram pos and some gram neg bacilli. Community acquired pneumonia, (Chlamydia, mycoplasma legionella)
35
Chloramphenical MOA, adverse rxns
Inhibits 50S ribosomal subunit (bacteriostatic), bone marrow toxicity, gray baby syndrome.
36
Chloramphenicol uses
broad spectrum gram pos and neg cocci and anaerobes (H flu, Neisseria meningitis, Chlamydia, mycoplasma, rickettsia)
37
Clindamycin MOA, adverse rxns
inhibits 50S ribosomal subunit. Severe diarrhea, pseudomembranous colitis
38
Clindamycin uses
narrow spectrum gram pos cocci (penicillin alternative), anaerobes, acne (topical)
39
List the streptogramins
quinupristin/ dalfopristin
40
streptogramins MOA
inhibits 50S
41
streptogramins uses
gram pos and some gram neg. Life threatening VREF
42
List the oxazolidinones
linezolid
43
linezolid MOA and uses
inhibits 50S. Gram pos and severe VREF, MSSA, MRSA and strep
44
Which antibiotics undergo hepatic elimination
CRIMES: clindamycin/ chloramphenicol, rifampin, isoniazid, metronidazole, erythromycins, sulfonamides/ streptogramins
45
List the inhibitors of folic acid metabolism
sulfonamides: trimethoprim/ sulfamethoxazole (intermediate acting) (sulfadiazine, sulfamethizole, sulfisoxazole, mafenide)
46
sulfonamides MOA
PABA analogues which Inhibit dihydropteroate synthase (of folic acid synthesis pathway). Selective toxicity b/c humans dont have DHPS or synthesize folic acid. Bacteriostatic
47
Trimethoprim MOA
Inhibit dihydrofolate reductase (of folic acid synthesis pathway). Selective toxicity b/c humans don’t synthesize folic acid. Used in synergy with sulfamethoxazole
48
sulfonamides pharmacokinetics
bacteriostatic with delayed onset of action (5-6hrs). Good oral absorption, widely distributes in tissues (including CSF).
49
sulfonamides metabolism/excretion
Hepatic metabolism by acetylation at N4- metabolite is inactive but less soluble. Increasing pH will increase renal excretion and decrease renal crystalluria (improve solubility)
50
sulfonamides toxicity
renal crystalluria precipitates, hemolytic anemia in pts with G6PD deficiency, hypersensitivity/ Stevens-Johnson syndrome, kernicterus (bilirubin deposition in brain of neonates), DDIs such as displacement of anticoagulants from plasma proteins
51
Sulfonamide uses
Broad spectrum (not used alone very much though): UTI (TMP/SMX), toxoplasmosis (sulfadiazine + pyrimethamine), nocardiosis (sulfa + AMP, erythro or streptomycin), chloroquine resistant malaria (sulfadoxine + pyrimethamine), pneymocystis carinii in AIDS, otitis media, prophylaxis of burn wounds (pseudomonas aeruginosa), sinusitis/ acute bacterial bronchitis (SMX/TMP), MRSA
52
sulfonamides mechanism of resistance
1. acquired: increased production of PABA, altered DHPTS, bacterial permeability. 2. escape: bacteria obtain methionine, homocysteine, serine, purines, thymine from pus. 3. Natural: organisms with no folic acid requirement are not susceptible
53
Why is surgical drainage important
Prevent escape mechanism of antibiotic resistance
54
Fluoroquinolones MOA
DNA gyrase inhibitor- bactericidal. Selective toxicity b/c humans don’t have gyrase
55
list fluoroquinolones
ciprofloxacin (2nd gen), levofloxacin (3rd gen), moxifloxacin (4th gen) (cinoxacin, enoxacin, nalidixic acid, gemifloxacin, norfloxacin, ofloxacin)
56
fluoroquinolones pharmacokinetics and toxicity/ DDI
orally available, broadly distributed. Toxicity: impair cartilage development/ causes erosion in children under 12, also contraindicated in pregnant women, hepatic damage DDI: inhibition of theophylline metabolism, increased risk of seizures with NSAIDs, antacids reduce oral absorption
57
Fluoroquinolone uses and resistance
gram neg and some gram pos. UTI, respiratory tract, soft tissue, some anaerobes, mycobacteria, prostatitis, STDs, GI tract infections.Resistance through shift in metabolic processes from acetate to lactate
58
List nitroimidazoles
Nitrofurantoin and metronidazole
59
Metronidazole MOA and uses
Degrades DNA- bactericidal. Anaerobic and protozoal infections (giardia, trichomoniasis, amebiasis), pseudomembranous colitis
60
nitrofurantoin MOA and uses
Degrades DNA- bacteriostatic. Gram negative bacteria. Prevention and treatment of UTI
61
Polymyxins MOA, uses, toxicity
Bactericidal- interacts with membrane phospholipids and lyses cells. Gram neg Pseudomonas meningitis (polymyxin B) and p. aeruginosa/ acinetobacter (polymyxin E). Highly nephrotoxic
62
Daptomycin MOA, uses, toxicity
Bactericidal- loss of membrane potential, inhibits protein/RNA/DNA synthesis. gram pos: MRSA, VISA, VRSA, VRE. Toxicity: rare eosinophilic pneumonia
63
bactericidal vs bacteriostatic for severe infections
bactericidal is best
64
List the bactericidal agents
penicillins, cephalosporins, vancomycin, aminoglycosides, fluroquinolones, rifampin, polymyxins, daptomycin
65
List bacteriostatic agents
sulfonamides, trimethoprim, tetracyclines, macrolides, clindamycin, chloramphenicol

ID unit 1 (12 decks)

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