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Pharmacology Unit 1 > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

4 broad categories of cell wall active agents

A
  1. beta lactams
  2. monobactams
  3. glycopeptides
  4. lipoglycopeptides
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2
Q

which class of antimicrobials affects the cell membrane?

A

lipopeptide

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3
Q

what is the MOA for all beta-lactams?

A

PBPs catalyze transglycosylation and transpeptidation

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4
Q

what are the 3 mechanisms of resistance seen in beta-lactams?

A
  1. enzymatic destruction
  2. reduced permeability
  3. target site alteration
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5
Q

what is the general spectrum of activity for all beta-lactams?

A

lack activity against atypicals (mycoplasma, chlamydia) and MRSA except ceftaroline

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6
Q

most beta-lactams are excreted by the ____ except which two?

A
  1. majority are renal

exceptions:

ceftriaxone - hepatobiliary

oxacillin - hepatic

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7
Q

with beta-lactams, there is an increase risk of seizures when using high-doses in patients with ____ dysfunction

A

renal

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8
Q

what are the 3 types of beta-lactams?

A
  1. penicillins
  2. cephalosporins
  3. carbapenems
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9
Q

what are the four types of penicillins?

A
  1. natural
  2. anti-staph
  3. amino
  4. extended spectrum
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10
Q

Penicillin G (IV) and Penicillin V (PO)

  1. Type of PCN
  2. Spectrum of Activity
  3. Clinical Uses of PCN V
  4. Clinical Uses of PCN G

(BOTH?)

  1. Side effects
A
  1. Natural PCN
  2. Gram (+) = strep, enterocci
    Anaerobes = in mouth; actinomyces, peptostreptococcus
  3. PCN V = GAS pharyngitits/streph throat, rheumatic fever
  4. PCN G = rheumatic fever, left-side endocarditis, syphilis

(MENINGOCOCCAL MENINGITIS)

  1. Hypersensitivity, GI
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11
Q

Oxacillin (IV), Nafcillin (IV), Dicloxacillin (PO)

  1. Type of PCN
  2. Spectrum of Activity
  3. Clinical Uses
  4. Side effects
  5. PEARLS
A
  1. Anti-staph
  2. Gram positive only - Strep and Staph (MSSA)
  3. SSTI, abscess, folliculitis, staph endocarditis, osteomyelitis, bacteremia, joint infection
  4. Hypersensitivity, GI, hepatotoxicity, delayed neutropenia, thrombophlebitis
  5. superior to vanco for MSSA, developed against penicillinase producing Staph
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12
Q

Ampillicin (IV) and Amoxicillin (PO)

  1. Type of PCN
  2. Spectrum of activity
  3. Clinical uses of Ampicillin
  4. Clinical uses of Amoxicillin

(BOTH?)

  1. Side effects
  2. PEARLS
A
  1. amino
  2. Gram positive = strep, enterococci, NOT staph, LISTERIA

little gram negative = possibly E. coli

  1. Amp = DoC for Enterococcal and Listeria infections
  2. Amox = upper respiratory tract infections, pneumonia, otitis media,

(Lyme disease, UTI)

  1. hypersensitivity, GI
  2. can add b-lactamase inhibitor to add gram (-) coverage
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13
Q

Ampicillin/sulbactam (IV), Amoxicillin/clavulanate (PO), Piperacillin/Tazobactam (IV)

  1. Type of PCN
  2. Spectrum of activity
  3. Clinical uses of Amox/Clav and Amp/Sul
  4. Clinical uses of PipTaz
  5. Side effects
A
  1. extended spectrum
  2. activity of parent drug + MSSA due to b-lactamase inhibitor
  3. Amox/Clav + Amp/Sul = upper respiratory infection incl. aspiration pneumonia, oral/dental infections, bite wounds, intra-abdominal infections
  4. PipTaz = pseudomonas, hospital acquired-infections
  5. Hypersensitivity, GI (esp. with Augmentin), aplastic anemia with PipTaz, acute interstitial nephrotoxicity with PipTaz
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14
Q

Imipenem+Cilastrin, Meropenem, Doripenem, Ertapenem

  1. Type of beta-lactam
  2. Spectrum
  3. Clinical Uses
  4. Side Effects
  5. PEARLS
A
  1. Carbapenems
  2. Broad coverage
    Gram (-) = pseudomonas expect ertapenem
    Gram (+) = NO MRSA
    Anaerobes = good activity
  3. MDR UTI, SSTI, HAP - crosses BBB/CSF
  4. Lowers seizure threshold
  5. Imipenem given with cilastrin to block renal peptidases

Ertapenem is the exception - no APE coverage, cross reactions with PCN

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15
Q

how many generations of cephalosporins?

what type of activity increases with subsequent generations?

A

5

gram (-)

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16
Q

what are the first generation cephalosporins?

A

Cephalexin (PO)

Cefazolin (IV)

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17
Q

what are the second generation cephalosporins?

A

Cefuroxime (IV,PO)
Cefaclor (PO)
Cephamycins: Cefotetan (IV), Cefoxitin (IV)

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18
Q

what are the third generation cephalosporins?

A

Ceftriaxone

Cefotaxime

Ceftazidime

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19
Q

what are the fourth generation cephalosporins?

A

Cefepime (IV)

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20
Q

what are the fifth generation cephalosporins?

A

Ceftaroline (IV)

21
Q

Cefazolin (IV), Cephalexin (PO)

  1. generation?
  2. spectrum?
  3. clinical uses
  4. side effects?
A
  1. First
  2. Gram (+) = strep, Staph/MSSA
    Gram (-) = PeCK
  3. SSTI, UTI, MSSA, NOT CNS infections
    Surgical prophylaxis with cefazolin
  4. cross-reaction with PCN allergy, Cefazolin better tolerated than oxacillin/nafcillin for MSSA
22
Q

Cefuroxime (IV/PO), Cefaclor (PO), Cefotetan (IV), Cefoxitin (IV)

  1. generation?
  2. spectrum?
  3. clinical uses
  4. side effects?
A
  1. second
  2. covers first generation plus gram (-) HENS
  3. sinusitis, otitis media, lower respiratory infection, colorectal + gyn surgery prophylaxis
  4. coagulopathy and disulfram+alcohol rxn with Cefotetan
23
Q

Ceftriaxone, Cefotaxime, Ceftazidime

  1. generation?
  2. spectrum?
  3. clinical uses of Ceftriaxone?
  4. clinical uses of Ceftazidime?
  5. side effects?
A
  1. third
  2. gram (+) = strep, MSSA
    gram (-) = enterobacteria, neisseria, PSEUDOMONAS w/ Ceftazidime
  3. Ceftriaxone = CAP, meningitis, complicated UTI, intra-abdominal + metronidazole, CSF lyme disease, streptococcoal endocarditis, gonococcal infection + PID
  4. Ceftazidime = Pseudomons concerning infections; post-surgical meningitis, neutropenic fever, UTI, HAP
  5. -greater association w/ c. diff
    - seizures with Ceftazidime in renal dysfunction
    - biliary sludging and kernicterus in neonates with Ceftriaxone
24
Q

Cefepime (IV)

  1. generation?
  2. spectrum?
  3. clinical uses?
  4. side effects?
A
  1. fourth
  2. broad!
    Gram (+) = strep, MSSA
    Gram (-) = pseudomonas, H. flu, Neisseria
  3. HAP, UTI, neutropenic fever, meningitis
  4. non-convulsive seizures in patients with renal dysfunction, altered mental status
25
Q

Ceftaroline (IV)

  1. generation?
  2. spectrum?
  3. clinical uses?
  4. side effects
A
  1. fifth
  2. Gram (+) = strep, MSSA, MRSA
    Gram (-) = NO PSEUDOMONAS, similar to 3rd generation
  3. complicated SSTI, persistent MRSA (+dapto)
  4. hematological effects, possible cross-reaction with PCN
26
Q

Aztreonam

  1. Class?
  2. Spectrum?
  3. Clinical uses
  4. side effects?
A
  1. Monobactams
  2. Only effective against gram (-); Neisseria, pseudomonas

NO anaerobes

  1. Reserved for gram (-) activity in those with severe PCN allergy
  2. well-tolerated
27
Q

Vancomycin (IV, PO)

  1. class?
  2. MOA?
  3. spectrum?
  4. clinical uses?
  5. side effects?
A
  1. Glycopeptides
  2. Inhibits late stages of cell wall synthesis by binding D-Ala-D-Ala
  3. Gram (+) = Strep, Staph (MSSA, MRSA), Enterococci, Clostridium, gram+ anaerobes
  4. MRSA, enterococcal infection (if PCN allergy), C. Diff (PO only), neutropenic fever

NOT FOR UTI, intra-abdominal infection unless post-sx

  1. red man syndrome, nephrotoxicity, hypersensitivity, drug fever, phlebitis
28
Q

Dalbavancin + Oritavancin

  1. Class?
  2. MOA?
  3. Spectrum?
  4. Clinical uses?
  5. PEARLS
A
  1. Lipoglycopeptides
  2. Inhibition of cell wall precursors
  3. gram (+) = MRSA, MSSA, strep, coagulase (-) staph
    anaerobes
    VRE w/ oritavancin
  4. SSTI
  5. expensive!
29
Q

Daptomycin (IV)

  1. Class?
  2. MOA?
  3. Spectrum?
  4. Clinical Uses?
  5. Side Effects?
A
  1. Lipopeptide
  2. inserts tail into gram(+) cell membrane causing depolarization
  3. broad spectrum gram (+); strep, staph (MSSA, MRSA), enterococci (+VRE)
  4. alternative to vancomyin for MRSA, NOT for pneumonia
  5. CPK elevation, skeletal muscle damage, peripheral neuropathy
30
Q

what classes of antimicrobials work on the 50S bacterial subunit?

bacteriostatic or -cidal?

A
  1. macrolides
  2. clindamycin (lincosamide class)
  3. oxazolidinones

bacteriostatic

31
Q

what classes of antimicrobials work on the 30S bacterial subunit?

bacteriostatic or -cidal?

A
  1. aminoglycosides
  2. tetracyclines
  3. glycylcyclines

bacteriostatic except aminoglycosides which are -cidal

32
Q

Azithromycin (IV/PO), Clarithromycin (PO), Erythromycin (IV/PO)

  1. Class?
  2. Spectrum?
  3. Clinical uses?
  4. Side Effects
A
  1. Macrolides
  2. Gram (+) aerobes = S. pneumoniae, B-hemolytic strep
    Gram (-) aerobes = H. influenzae, M. catarrhalis
    Other = atypicals, actinomyces
  3. Uncomplicated upper and lower respiratory infections, mycobacterial infection, H. pylori
  4. GI, thrombophlebitis with erythromycin, QT prolongation
33
Q

Clindamycin

  1. Spectrum?
  2. Clinical use?
  3. Side effects
A
  1. Gram (+) aerobes = Staph (MSSA, MRSA), Strep
    Anaerobes = Clostridium, peptostreptococcus, B. fragilis
    Others = Toxoplasmosis, malaria
  2. surgical prophylaxis, SSTI, toxoplasmosis, combo with PCN for TSS, combon w/ quinine for malaria
  3. diarrhea, pseudomembranous colitis (c. diff)
34
Q

Linezolid (IV/PO), Tedizolid (PO)

  1. Class?
  2. Spectrum?
  3. Clinical uses?
  4. Side effects
A
  1. Oxazolidinones
  2. Gram (+) = staph (MRSA, MSSA), strep, enterococcus + VRE
  3. SSTI, CAP 2/2 S. aureus
  4. Hematologic toxicity, reversible myelosuppression, mitochondrial toxicity, serotonin syndrome
35
Q

Gentamicin (IV, IM), Tobramycin (IV/IM/Neb), Amikacin (IV/IM), Streptomycin (IM)

  1. Class?
  2. Spectrum?
  3. Clinical Uses?
  4. Side effects?
  5. Pharmacokinetics/dynamics
A
  1. Aminoglycosides
  2. Gram (-) = enterobacteriaceae, pseudomonas
    Gram (+) = synergistic activity with cell wall active agents
  3. UTI, HAP, cystic fibrosis (inhaled), open fracture prophylaxis with Cefazolin
  4. nephrotoxicity, ototoxicity, neuromuscular blockade
  5. high concentration in urine, poor entry to brain and lung
36
Q

Doxycycline (IV, PO), Minocycline (IV, PO), Tetracycline (PO)

  1. Class?
  2. Spectrum?
  3. Clinical uses?
  4. Side effects?
  5. Interactions
A
  1. Tetracyclines
  2. Gram (-) = H. flu, neisseria, acinetobacter baumannii
    Gram (+) = strep pneumonia, CA-staph (MRSA, MSSA)
    Other = atypicals, spirochetes, rickettsiae, mycobacterium
  3. tick-borne illnesses, CAP, SSTI 2/2 MRSA/MSSA, acne, H. pylori combo, malaria prophylaxis
  4. GI, photosensitivity, neurotoxicity, bone growth (pregnancy contraindication)
  5. decreased absorption with divalent cations; Fe, Ca, Mg
37
Q

Tigecycline

  1. Class?
  2. Spectrum?
  3. Clinical uses?
  4. Side effects?
A
  1. Glycylcyclines
  2. Gram (+) = Staph (MSSA, MRSA), Enterococci (+VRE), Strep

Gram (-) = broad except Pseudomonas

Anaerobes = Clostridum, bacteriodes fragilis

  1. Intra-abdominal infection, polymicrobial SSTI, MDR 2/2 CRE

NOT for bacteremia

  1. GI, transaminitis, black box warning
38
Q

what are the major classes of nucleic acid synthesis inhibitors?

A
  1. Fluroquinolones
  2. Metronidazole
  3. Bactrium
  4. Rifamycins
39
Q

Ciprofloxacin (IV/PO), Levofloxacin (IV/PO), Moxifloxacin (IV/PO), Delafloxacin (IV/PO)

  1. Class?
  2. MOA?
  3. Spectrum?
  4. Clinical uses?
  5. Side effects?
  6. Pharmacokinetics?
  7. Drug interactions?
A
  1. Fluroquinolones
  2. Inhibit DNA gyrase and topoisomerase iV
  3. Gram (-) = enterobacteriacease, H. flu, Pseudomonas
    Gram (+) = P. pneumoniae, staph
    Anaerobes = B. fragilis
    Atypicals = legionella, chlamydia, mycoplasma
  4. UTI (not M), CAP (M and L), HAP (C and L), bone and joint infection, SSTI (D), GI and intra-abdominal infection, STDs, cutaneous anthrax, TB
  5. C. diff (NAP1 strain), CNS symptoms, tendon rupture, QT prolongation
  6. well-absorbed with extensive distribution, variable CSF penetration
  7. decreased absorption with di- and tri-valent cations
40
Q

Metronizadole

  1. MOA?
  2. Spectrum?
  3. Clinical uses?
  4. Side effects?
A
  1. loss of helical structure and strand breakage
  2. anaerobes = B. fragilis, Clostridial species (C.diff)
    Protozoa = trichomonas, giardia, entamoeba histolytica
  3. C. diff diarrhea, trichomoniasis, intra-abdominal infections & surgical prophylaxis w/ cephalosporins
  4. metallic taste, GI, peripheral neuropathy, disulfram rxn with EtOH
41
Q

Trimethroprim/Sulfamethoxazole (IV/PO)

  1. AKA?
  2. MOA?
  3. Spectrum?
  4. Clinical uses?
  5. Side effects?
A
  1. Bactrim
  2. inhibition of folic acid
  3. Gram (+) = CA-MSSA/MRSA, S. pneumoniae, listeria
    Gram (-) = DoC for Stenotrophomonas, Enterobacteriaceae
    Other = Pneumocystitis in HIV patients
  4. uncomplicated UTI, listeria meningitis, S. aureus STTI
  5. SJS/TEN, bone marrow suppression, acute interstitial nephritis
42
Q

Nitrofurantoin

  1. Only used for?
  2. Spectrum?
  3. Side effects?
A
  1. UTI, uncomplicated cystitis
  2. Gram (+) = Enterococcus (+VRE)
    Gram (-) = E. coli (excellent coverage), NO PSEUDOMONAS
  3. GI (N/V), neurotoxicity, pulmonary reactions
43
Q

Rifampin (IV/PO), Rifabutin (PO), Rifaximin (PO)

  1. Class?
  2. MOA?
  3. Spectrum?
  4. Drug interactions?
A
  1. Rifamycins
  2. Binds to RNA polymerase, blocking RNA synthesis
  3. Gram (+) = staph, strep, C. diff, Listeria
    Gram (-) = H. flu, meningitis, H. pylori
    Mycobacterium
  4. CYP, P-glycoprotein
44
Q

Rifampin (IV/PO)

  1. Clinical uses?
  2. Adverse effects?
A
  1. M. tuberculosis, mycobacterium infections,
    prosthetic valve endocarditis or prosthetic joint infections, meningitis prophylaxis
  2. latent flu-like symptoms, thrombocytopenia,
    renal failure
45
Q

Rifabutin (PO)

  1. Clinical uses?
  2. side effects?
A
  1. MAC or Tb

2. Uveitis, leukopenia, polyarythralgia

46
Q

Rifaximin (PO)

  1. Clinical uses?
A
  1. hepatic encephalopathy, recurrent c. diff, traveler’s diarrhea
47
Q

Isoniazid (INH)

  1. class?
  2. MOA?
  3. side effects?
A
  1. Anti-Tb
  2. inhibition of mycolic acid synthesis
  3. hepatitis, neurotoxicity (peripheral neuropathy, memory loss, psychosis), hypersensitivity
48
Q

Pyrazinamide

  1. class?
  2. MOA?
  3. side effects?
A
  1. Anti-Tb
  2. UNKNOWN
  3. N/V, hepatotoxicity, hypersensitivity
49
Q

Ethambutal

  1. class?
  2. MOA?
  3. side effects?
A
  1. Anti-Tb
  2. inhibits biosynthesis of cell wall
  3. optic neuritis, neuropathy

Pharmacology Unit 1 (5 decks)

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