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Pharm > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

What does a gram (+) stain look like

A

purple, single lipid bilayer with thick pept. cell wall

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2
Q

What does a gram (-) stain look like

A

red, double lipid bilayer with thin pept. cell wall

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3
Q

Cocci

A

spherical

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4
Q

Bacilli

A

rod

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5
Q

Aerobic

A

oxygen loving

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6
Q

Anaerobic

A

oxygen hating

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7
Q

Blood brain barrier- factors influencing drug penetration

A
  • Protective mechanism = stops entry into brain
  • Single layer tile-like endothelial cells fused by tight junctions
  • Resistant to hydrophilic drugs
  • Gain entry = high lipophilicity, increased inflammation of BBB, low molecular weight, decreased binding (free serum overall)
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8
Q

Bacteriostatic

A

stops growth of bacteria and limits spread of infection during immune system attack

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9
Q

Bacteriocidal

A

kills bacteria

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10
Q

Bacteriostatic list

A

CLM, TTTT, SSSS
Clindamycin*
Linezoid
Macrolides*

Tetracycline
Tigecycline
Trimethoprim

Sulfonamides
Spectinomycin
Synercid

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11
Q

Bacteriocidal list

A

A B C D
FVM

Aminoglycosides
Beta-lactam
Cephalosporines
Daptomycin
Fluroquinolies
Vancomycin
Metronidazole
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12
Q

Gram (+) pearls

A
  • Staphylococcus
  • Streptococus
  • Enterococcus
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13
Q

Gram (-) pearls

A 
Haemophilius influenza (easy to treat)
FENCE bugs (easy/hard)
SPACE bugs (hard to treat)
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14
Q

FENCE bugs

A

Proteus mirabilis
E. Coli
Klebsiella PNA

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15
Q

SPACE bugs

A
  • Serratia
  • Pseudomonas
  • Acinetobacter
  • Citerobacter
  • Enterobacter
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16
Q

Organism susceptibility

A

a guide for choosing antimicrobial therapy once a pathogen is cultured. Includes MIC, MBC, antibiogram

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17
Q

Concentration dependent killing

A

significant increase in rate of bacterial killing as the concentration of abx increases (cmax) à more rapid killing

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18
Q

Two meds that use concentration dependent killing are?

A

o Aminoglycosides

o Fluoroquinolones

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19
Q

Time dependent killing

A

increasing the concentration of antibiotic does not increase the rate of kill. It is based on clinical efficacy via percentage of time that blood concentration of the drug remain above the MIC (fT >MIC)

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20
Q

Post antibiotic effect

A

persistent suppression of microbial growth that occurs after levels of abx have fallen below the MIC

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21
Q

Narrow Spectrum

A

single/limited group of microorganisms

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22
Q

Extended Spectrum

A

gram (+) organisms and significant number of gram (-) organisms

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23
Q

Broad Spectrum

A

wide variety of microbial species (precipitates superinfections)

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24
Q

Combination therapy

A

combo of abx/synergism with a disadvantage of interfering with mechanisms of action, overuse, and cost

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25
Q

Synergy

A

combination drugs, better coverage together than alone

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26
Q

Resistance

A

genetic alterations, altered expression of protein

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27
Q

Genetic alterations

A

DNA/protein mutations à xfer drug resistence

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28
Q

Altered expression of proteins

A

modification of target sites, decreased accumulation (efflux pumps), and enzymatic inactivation (B-lactamases, acetyltransferases, esterases)

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29
Q

Superinfections

A

broad spectrum/combo of agents can lead to alterations of the normal microbial flora

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30
Q

the two big super infections are

A

C Diff

Yeast

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31
Q

What drug uses enzymatic inactivation as their MoR?

A

beta lactams

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32
Q

What drug uses modification of target site for their MoR?

A

Vancomycin

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33
Q

What drug uses:
enzymatic inactivation
Efflux pump
and ribsomal protective proteins as its MoR?

A

tetracycline

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34
Q

What drug uses:
alteration in amino glycoside uptake
modifying enzymes
alterations in ribosomal binding site for its MoR

A

aminoglycosides

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35
Q

What drug uses:
decreased accumulation/efflux pump
modification of target site (mef/erm) for its MoR ?

A

macrolides

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36
Q

What drug uses:
altered target sites
efflux pump for its MoR?

A

clindamycin

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37
Q

What drug uses:
alterations in ribosomal binding sites
enzymatic inactivation and
efflux pump for its MoR?

A

synercid

38
Q

What drug uses alterations in ribosomal binding sites for its MoR?

A

linezoid

39
Q

What drug uses alterations in target sites and
DNA
active cell wall permeability and
efflux pump for its MoR

A

fluoroquinolones

40
Q

What drug uses impaired oxygen scavenging and alter ferrodoxin levels for its MoR?

A

metronidazole

41
Q

What drug uses increased PABA production and point mutations as its MoR?

A

TMP-SMX

42
Q

4 sites of action of antimicrobials

A
  • Inhibitors of cell wall synthesis
  • Inhibitor of protein synthesis
  • Inhibitors of nucleic acid function or synthesis
  • Inhibitors of metabolism
43
Q

which class are inhibitors of cell wall synthesis

A 
beta lactams (PCMC)
vancomycin
44
Q

which classes are inhibitors of protein synthesis

A

tetracyclines
aminoglycosides
macrolides

45
Q

which classes are inhibitors of nucleic acid formation or synthesis

A

Fluoroquinolones

46
Q

which class is inhibitors of metabolism

A

TMP-SMX

47
Q

Patient factors influencing selection of agents

A 
Immune system 
Renal dysfunction and Hepatic dysfunction – (may need dose decrease) 
Poor perfusion (may need dose increase) 
Age 
Pregnancy 
Lactation
48
Q

Beta Lactams

A

Beta Lactamase Enzymes
Ethanol intolerance
Cephalosporin MTT side chain, hypoprothrombinemia (low vit K)
Neuro/Hem/GI
Interstitial Nephritis
Hypersensitivity (rash, anaphylaxis, death), Antibody production against penicillins

49
Q

Cephalosporins can’t cover what bug?

A

Enterococcus

50
Q

Cephalosporin generation 1

A

gram (+) aerobes, limited with few gram (-) aerobes

51
Q

Cephalosporin generation 2

A
  • gram (+) aerobes, more active with gram (-) aerobes, 3 work on anaerobes (cefoxitin, cefotetan, cefmetazole)
52
Q

Cephalosporin generation 3

A

less active against gram (+) greater against gram (-) aerobes

53
Q

Cephalosporin generation 4

A

am (+) aerobes (ceftriaxone), gram (-) aerobes including pseudomonas aeruginosa and beta lactamase producing enterobacter sp.

54
Q

Cephalosporin generation 5

A

best gram (+) coverage, CAP (MRSA), infections of skin/subcut tissue

55
Q

which cephalosporins work on anaerobes?

A

cefoxitin
cefotetan
cefmetazole

56
Q

T/F vancomycin treats gram (+) only

A

true

57
Q

Vancomycin AEs/Contras

A
  • Red-Man Syndromes (rate of infusion)
  • Nephrotoxicity
  • Ototoxicity
  • Neutropenia/Thrombocytopenia
  • Thombophlebitis
58
Q

Tetracyclines AEs/Contras

A

•Effects on calcified tissue/bone and teeth deposition in pregnant women/children under 8
GI- N/V/D, pseduomembranous colitis
• Hypersensitivity- rash, pruritis, anaphylaxis, angioedema, urticaria
• Photosensitivity
• Hepatotoxicity
•

59
Q

Aminoglycosides AEs/Contras

A

• Nephrotoxicity
o Nonoliguric azotemia (proximal tubule damage)
o Risk for elderly, underlying renal dysfuction with long therapy
• Ototoxicity
o 8th CN damage with irreversible vestibular/auditory toxicity
o Vestibular- dizziness, vertigo, ataxia (S,G,T)
o Auditory- tinnitus, decreased hearing (A,G)

60
Q

Macrolides AEs/Contras

A 
•	QTc prolongation
•	GI
o	N/V/D, dyspepsia
o	Erythro most common
•	Cholestatic hepatitis
•	Thrombophlebitis
•	Ototoxicity
•	Allergy
61
Q

Clindaymycin AEs/Contras

A
  • most associated w/ Cdiff
  • GI symptoms
  • Allergy
  • Hepatotoxicity
62
Q

which medication causes c diff the most

A

clindamycin

63
Q

linezolid- Zyvox

A

o ADE= thrombocytopenia with tx >2wks, headaches, thrombocytopenia, reversible optic/peripheral neuropathy
o caution w/ SSRIs- serotonin syndrome, MOI

64
Q

• Tigecycline (Tygacil)-

A

o D/N/V
o Acute pancreatitis
o Tooth discoloration

65
Q

Fluoroquinolones

A
  • covers atypical pathogens
  • not recommended in pediatrics d/t tendon rupture,
  • difference between newer and older agents and gram positive coverage,
  • CNS issues
  • Hepatotoxicity
  • QTc prolongation…watch with other prolonging agents
  • GI issues
  • Must take 2 hours before or 4hrs after chelation with calcium, iron, aluminum, Mg meds
66
Q

T/F Fluroroquinolones have post antibiotic effect

A

True

67
Q

o TMP-SMX-

A 
•	GI issues
•	Hematologic- leucopenia, thrombocytopenia, eosinophilia (should stop therapy)
•	Dermatologic- sulfa allergy
o	Steven Johnson Syndrome
o	Photosensitivity 
o	Rash
•	CNS- aseptic meningitis, sz, headaches
•	Crystalluria
68
Q

Metronidazole

A
  • GI issues
  • CNS (caution with preexisting CNS disorders)
  • Disulfiram reaction with ETOH
69
Q

Synercid

A
  • venous irritation
  • GI symptoms
  • Rash
  • Myalgias
  • Hyperbilirubinemia
  • Interaction warning= CYP3A4 inhibitor (Ca2+ blockers, cyclosporine, warfarin, HIV meds, statins, diazepam)
70
Q

o Endemic Mycoses:

A
  • Histoplasmosis
  • Coccidiodomycosis
  • Blastomycosis
71
Q

o Opportunistic Mycoses:

A
  • Cryptococcosis
  • Candidiasis
  • Aspergillosis
  • Zygomycosis
72
Q

3 types of polyenes

A

Ampho B
Lipid Ampho B
Nystatin

73
Q

Ampho B

A
  • Fungicidal/Fungistatic
  • Does NOT penetrate CSF
  • AEs-
  • Infusion related (fever, chills)-premed
  • Nephrotoxicity-give fluids before and after
  • Elevated liver enzymes
  • Hypokalemia
  • Hypomag
74
Q

o Lipid-based Ampho B

A
  • Advantages- higher tissue conc, decreased infusion related reactions, marked decreased in nephrotoxicity, increased daily dose
  • Good for people with renal insufficiency
75
Q

o Nystatin

A
  • Topical only

* Candida suppression

76
Q

• Pyrimidines (Flucytosine)

A
  • Combined with Ampho B
  • Penetrates CSF
  • AEs-
  • Neutropenia
  • Thrombocytopenia
  • Bone marrow depression
  • Hepatic dysfuction
  • GI symptoms
77
Q

what are the 4 azoles

A

Itraconazole
Fluconazole
Voriconazole
Posaconazole

78
Q

Azoles

A
  • AEs-
  • GI-N/V abd pain, elevated LFTs
  • Prolonged QTc
  • Visual disturbances (voriconazole)
  • Rash
  • Nephrotoxicity
79
Q

what are the 3 echincandins

A

Caspofungin
Micafungin
Anidulafungin

80
Q

echincandins

A
  • AEs- overall tolerated well
  • N/V
  • Flushing
  • Elevated LFTs
  • Infusion reaction
  • Phlebitis
  • Hypokalemia
81
Q

• Griseofluvin

A 
o	Used for dermatophytosis
o	AEs
•	Serum sickness
•	Hepatitis
o	Drug Interactions
•	Warfarin
•	Phenobarb
82
Q

• Terbinafine

A

o AEs
• GI upset
• Headache

83
Q

• Topical Agents

A

o Miconazole
o Clotrimazole
• OTC
• Used for vulvovaginal candida or dematophytic infections

84
Q

T/F • Viruses obligate intracellular parasites- invade host cells

A

True

85
Q

• Acyclovir

A

o Treats HSV and VZV
o renal toxicity w/ IV
o neuro toxicities
o high doses of valtrex can cause HUS, thrombocytopenia, seizures, hallucinations, confusion

86
Q

o Amantadine and Rimantadine-

A

• use for Influenza A only, high levels of resistance

87
Q

o Oseltamivir and Zanamivir-

A
  • Activity against Influenza A and B

* Should be administered w/i 30 hours of symptom onset – and not after 48hrs

88
Q

what bacteria are not covered by carbapenems?

A

MRSA
VRE
Cdiff

89
Q

Monobactams only work against?

A

gram (-) aerobes

90
Q

Vanc only works against?

A

gram (+) aerobes

Pharm (3 decks)

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