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Antimicrobials Flashcards

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1
Q

Penicillin family

A
  • MOA: weakens cell wall
  • Spectrum: variety of bact.
  • Structure: Beta-lactam ring
  • ADVERSE: allergy likely - #1 allergy drug, likely allergic to similar drugs
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2
Q

Beta-Lactam Family

A
  • 4 sided Beta-lactam Ring
  • Includes: Penicillin Cephalosporin Aztreonam Imipenem Meropenem Ertapenem
  • ***ADD PICTURE
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3
Q

Penicillin G (Benzylpenicillin) (&V)

A
  • Quintessential**
  • Family: Penicillin
  • Spectrum: Narrowest
  • Sensitivity: Penicillinase (Xed by <—)
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4
Q

Nafcillin

A
  • Family: Penicillin
  • Spectrum: Narrow Spectrum of Penicillin family
  • Sensitivity: none? (resistant to penicillinase)
  • Target: Staphylococcus Aureus
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5
Q

Oxacillin

A
  • Family: Penicillin
  • Spectrum: Narrow
  • Sensitivity: none? (resistant to penicillinase)
  • Target: Staphylococcus Aureus
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6
Q

Dicloxacillin

A
  • Family: Penicillin
  • Spectrum: Narrow
  • Sensitivity: none? (resistant to penicillinase)
  • Target: Staphylococcus Aureus
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7
Q

Ampicillin

A
  • Family: Penicillin
  • Spectrum: Broad-Spectrum (Aminopenicillins)
  • Sensitivity: Penicillinase sensitive
  • ALT: Unasyn (Ampicillin/sulbactam)
  • Target: Gram +, more Gram -
  • Example: Haemophilus influenzae, E-coli, Proteus mirabilis, enterococci, Neisseria Gonorrhoeae
  • ADVERSE: Rash and Diarrhea
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8
Q

Amoxicillin

A
  • Family: Penicillin
  • Spectrum: Broad-Spectrum (Aminopenicillins)
  • Sensitivity: Penicillinase
  • ALT: Augmentin (Amoxicillin/clavulanic acid)
  • Target: Gram +, more Gram -
  • Example: Haemophilus influenzae, E-coli, Proteus mirabilis, enterococci, Neisseria Gonorrhoeae
  • ADVERSE: Rash and Diarrhea
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9
Q

Ticaracillin

A
  • Family: Penicillin
  • Spectrum: Extended-Spectrum
  • Sensitivity: Penicillinase (X by <—)
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10
Q

Pipercillin

A
  • Family: Penicillin
  • Spectrum: Extended-Spectrum
  • Sensitivity: Penicillinase (X by <—)
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11
Q

Bacterial Resistance to Penicillins

A
  1. Inactivation by bacterial enzymes EX: penicillinase or beta-lactamase
  2. PBP alteration - alter sites of penicillin binding (MRSA)
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12
Q

Penicillin Allergy

A
  • Immediate - 2-30 mins (most severe)
  • Accelerated - 1-72 hours
  • Delayed - 1 day - weeks
  • Anaphylaxis - Laryngeal edema, Bronchoconstriction, Severe Hypotension
  • ***EPINEPHERINE to Treat*****
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13
Q

Aminoglycocsides

A
  • Therapeutic: Work together with Penicillin
    1. Penicillin breaks cell wall
    1. Aminoglycoside sweeps in to block protein synthesis
  • ADVERSE: dosing together will inactivate!
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14
Q

Bacteriostatic Antibiotics

A

Reduces rate of bacterial growth ADVERSE: negates effect of bacteriocides (ie Penicillins) - these need high bacteria growth to lyse cell walls and kill

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15
Q

Probenecid

A

ADVERSE: delays excretion of penicillin from body = BAD

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16
Q

Beta-lactamase inhibitors

A
  • Clavulanic Acid, Tazobactam, sulbactam
  • MOA: extends antimicrobial spectrum of penicillinase sensitive antibiotics (suppresses activity of -ase enzyme)
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17
Q

Unasyn

A

Ampicillin/sulbactam Antibiotic + Penicillinase-suppressor

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18
Q

Augmentin

A

Amoxicillin and clavulanic acid Antibiotic + Penicillinase-suppressor

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19
Q

Timentin

A

Ticarcillin/clavulanic acid Antibiotic + Penicillinase-suppressor

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20
Q

Zosyn

A

Piperacillin/tazobactam Antibiotic + Penicillinase-suppressor

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21
Q

Cephalosporin Family

A
  • Family: Beta-lactam (similar to penicillin)
  • MOA: bacteriocide- bind to penicillin proteins and lyse cell wall - prefer dividing cells
  • Route: parenteral usually
  • Sensitive: less sensitive to cephalosporinase (B-lactamase) as generations progress, 1+2 especially sensitive
  • ADVERSE: low toxicity BUT allergy, bleeding, thrombophlebitis
  • D v. D:
    • Probenecid - delays renal excretion
    • Alcohol - can cause alcohol poisoning Drugs that promote bleeding: Cephalosporins can also promote bleeding
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22
Q

Cephalexin

A
  • Family: Cephalosporin
  • Generation: 1st
  • Route: Parenteral usually
  • Therapeutic: most active against gram +, Prophylaxis for surgical patients, Rarely used for active infections
  • ADVERSE: low toxicity BUT allergy, bleeding, thrombophlebitis
  • D v. D:
    • Probenecid - delays renal excretion
    • Alcohol - can cause alcohol poisoning
    • Drugs that promote bleeding: Cephalosporins can also promote bleeding
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23
Q

Cefoxitin

A
  • Family: Cephalosporin
  • Generation: 2nd
  • Route: Parenteral usually
  • Therapeutic: not many. Oral cefuroxime - otitis, siusitis, URIs
  • ADVERSE: low toxicity BUT allergy, bleeding, thrombophlebitis
  • D v. D:
    • Probenecid - delays renal excretion
    • Alcohol - can cause alcohol poisoning
    • Drugs that promote bleeding: Cephalosporins can also promote bleeding
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24
Q

Cefotaxime

A
  • Family: Cephalosporin
  • Generation: 3rd
  • Route: Parenteral usually
  • Therapeutic: preferred for multiple infections, HIGHLY active. For gram -, CSF penetration, used only when necessary
  • ADVERSE: low toxicity BUT allergy, bleeding, thrombophlebitis
  • D v. D:
    • Probenecid - delays renal excretion
    • Alcohol - can cause alcohol poisoning
    • Drugs that promote bleeding: Cephalosporins can also promote bleeding
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25
Q

Cefepime

A
  • Family: Cephalosporin
  • Generation: 4th
  • Route: Parenteral usually
  • Therapeutic: Health care and hospital pneumonias, esp. resistant Pseudomons
  • ADVERSE: low toxicity BUT allergy, bleeding, thrombophlebitis
  • D v. D:
    • Probenecid - delays renal excretion
    • Alcohol - can cause alcohol poisoning
    • Drugs that promote bleeding: Cephalosporins can also promote bleeding
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26
Q

Ceftaroline

A
  • Family: Cephalosporin
  • Generation 5th
  • Route: Parenteral usually
  • Therapeutic: MRSA
  • ADVERSE: low toxicity BUT allergy, bleeding, thrombophlebitis
  • D v. D:
    • Probenecid - delays renal excretion
    • Alcohol - can cause alcohol poisoning
    • Drugs that promote bleeding: Cephalosporins can also promote bleeding
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27
Q

Cefatriaxone

A
  • Family: Cephalosporin
  • Gen: Unknown ****FILL. IN*******
  • ADVERSE: plus calcium = highly toxic/fatal precipitates
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28
Q

Cefuroxime

A
  • Family: Cephalosporin
  • Gen: 2nd
  • Therapeutic: Oral - otitis, siusitis, URIs
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29
Q

Imipenem

A
  • Family: Carbapenems
  • AKA: Primaxin
  • Therapeutic: most bacteria and resistant bacteria NOT MRSA, HIGH active gram + cocci and many gram - cocci and bacilli
  • **Most effective beta-lactam against anaerobic bacteria
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30
Q

Vancomycin

A
  • Family: ?
  • MOA: lyses cell wall, no B-lactam ring
  • Route: IV - (GI absorbtion poor)
  • AKA: Vancocin, Vancoled
  • Therapeutic: severe infections only
  • Example: MRSA, Staph-epidermidis, Cdiff
  • ADVERSE:
    • Ototoxicity (sometimes permanent)
    • Red man syndrome
    • Thrombophlebitis (common)
    • Thrombocytopenia (rare)
    • Allergy Renal failure
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31
Q

Red man syndrome

A

Flushing, rash, pruritus (itching), uticaria (hives), tachycardia, hypotension

32
Q

Tetracyclines

A
  • MOA: Bacteriostatic inhibitor of Protein Synthesis (slows down)
  • Spectrum: Broad
  • Types: Tetracycline, Demeclocycline, Doxycycline, Minocycline (pharmkin. Differences)
  • Route: Oral, absorbtion reduced by food (Chelation = insoluble chelates formed with Ca2+) (no milk, iron, magnesium lax, antacid)
  • Bact. Resistance: Has started to occur
  • Therapeutic: Acne, peptic ulcer disease, periodontal disease, rheumatoid arthritis, mycoplasma pneumoniae, lyme, anthrax, H. Pylori
  • ADVERSE:
    • GI irritant
    • Discolor teeth esp children
    • superinfections
    • hepatotoxicity(esp high dose IV)
    • renal toxicity (excreted in urine)
    • photosensitivity
33
Q

Tetracycline and Demeclocycline

A

Accumulated in patients with kidney disease

34
Q

Erythromycin

A
  • Family: Macrolide
  • MOA: Inhibition of protein synthesis - slows down (sometimes bactericidal)
  • Spectrum: Broad
  • Therapeutic use: Allergic to Penicillin, Most gram + some gram -
  • Specific Use: Whooping cough, acute diphtheria, Corynebacterium diphtheriae, chlamydial infections, M. Pneumoniae, Group A strep. Pyogenes
  • D v. D: Hepatic enzyme inhibitor *ex. Theophylline, carbamazepine, warfarin
  • ADVERSE:
    • GI
    • QT elongation + sudden cardiac death
    • superinfections
    • thrombophlebitis
    • hearing loss (transient)
35
Q

Clyndamicin

A
  • Family: ????****
  • MOA: Bacterial Static Inhibitor of Protein Synthesis
  • Therapeutic: Anaerobic Bacteria (gram + and gram -)
  • Use Example: Anaerobic infections outside of CNS, alternative to penicillin
  • ADVERSE:
    • C. Diff cause
    • hepatic toxicity
    • Blood dyscrasias (blood cell disorder)
    • Diarrhea
    • Hypersensitivity Rxn (allergy)
36
Q

Linezolid

A
  1. Class: Oxazolidinones (new)
  2. MOA: Bacteriostatic inhibitor of Prot. Syn.
  3. Use: MDR-gram +, aerobic and facultative gram +
  4. EX: VRE, MRSA
  5. Resistance: Unlikely
  6. ADVERSE: Diarrhea, N/V, Headache, myelosuppression
  7. DvD: Inhibitor of MAO so with Monoamine oxidase inhibitors (MAOI) = Hypertensive crisis
37
Q

Telithromycin

A
  1. Class: Ketolide (Prototypic) (like erythromycin and other macrolides)
  2. Use: Streptococcus pneumoniae
  3. ADVERSE:
    1. Severe liver injury
    2. GI effects
    3. Visual disturbances
    4. Prolonged QT interval
38
Q

Aminoglycosides

A
  1. Class: Aminoglycosides
  2. Spectrum: Narrow
  3. Type: Gentamicin, tobramycin, amikacin
  4. MOA: BacteriCIDal Inhibitor of Prot. Synthesis
  5. Use: Aerobic, gram- bacilli
  6. ADVERSE:
    1. ototoxic
    2. nephrotoxic
    3. Hyper sensitivity
    4. Blood dyscrasias
  7. DvD GOOD: Penicillin, Cephalo, Vacomycin
  8. DvD BAD:
    1. Neuromuscular blocker/skeletal muscle relaxants - do not interact well with neuromuscular blockers, general anesthetics and in myasthenia gravis
    2. Ototoxic drugs
    3. nephrotoxic drugs
  9. Route: Parenteral - no oral
  10. Treatment of choice: Reversal with IV Infusion of a calcium salt
  11. SERUM LEVELS: Diff. Plasma levels in diff. Patients - watch out for trough creep (test peak 30 mins after, test trough immediately before next dose or 1 hour before if only 1x per day)
39
Q

Gentamicin

A
  1. Class: Aminoglycoside
  2. Use: aerobic gram- bacilli
  3. EX: Pseudomonas aeruginosa, E. Coli, Klebsiella, Serratia, Proteus mirabilis
  4. ADVERSE: Nephrotoxicity, Ototoxicity
40
Q

Sulfonamides

A
  1. Spectrum: broad
  2. Similar to: Trimethoprim
  3. MOA: Suppress bacterial growth by inhibiting tetrahydrofolic acid (folic acid cycle)
    1. *mammals intake folic acid, bacteria synthesize it
  4. USE: UTI, Nocardiosis, Chlamydia trachomatis, toxo/malaria, ulcerative colitis
  5. ADVERSE:
    1. Hypersensitivity - Stevens-Johnson syndrome
    2. Hemolytic anemia
    3. Kernicterus
    4. Renal damage from crystalluria
  6. DvD:
    1. intensifies - warfarin, phenytoin, sulfonylureas.
    2. Cross hypersensitivity - thiazide, diuretics, loop diuretics and sulfonylureas
  7. Fun facts: first drug available for systemic bact. Infection (better drugs now available)
41
Q

Trimethoprim

A
  1. MOA: inhibits dihydrofolate reductase (key enzyme in conv. B/t dihydrofolic acid to active tetrahydrofolic acid = suppress DNA/RNA/Protein in bacteria)
  2. USE: Acute, uncomplicated UTI, EColi, Proteus Mirabilis, Klebsiella pneum., Enterobacter, coagulase-negative staph.
  3. ADVERSE:
    1. Megoblastic anemia
    2. thrombocytopenia
    3. neutropenia
    4. Hyperkalemia
    5. teratogenic (folate deficiency)
42
Q

TMP/SMZ

A
  1. Combo: Trimethoprim/Sulfamethoxazole
  2. MOA: Inhibits several sequential steps in folic acid synth. - more powerful
  3. Route: Plasma levels should be 1:20 ratio
  4. USE: UTI, otitis media, bronchitis, shigellosis, pneumonia from Pneumocystis jiroveci, “”pneumonia and GI
  5. ADVERSE: GI-N/V, Rash, Hyperkalemia, Hypersensitivity (Stevens-Johnson) = blood dyscrasias, kernicterus, Crystallura (renal damage)
43
Q

Fluoroquinolones

A
  1. Spectrum: Broad/many applications
  2. MOA: Disrupt DNA replication and cell division
  3. Route: oral or IV
  4. ADVERSE: tendon rupture (achilles heel)
    1. Population = under 18, over 60, with Kidney, Heart or Lung Transplant
  5. DvD: Glucocorticoids (Tendon rupture)
44
Q

Ciprofloxacin

A
  1. Class: Fluoroquinolone
  2. Spectrum: Broad
  3. MOA: inhibits DNA gyrase and topoisomerase II
  4. Use: Gram - and some gram +
  5. EX: multiple system infections, Respiratory, UTI, GI, bones, joints, skin and soft tissue
  6. DRUG OF CHOICE: Anthrax
  7. ADVERSE: Mild - GI (N/V, diarrh., abdom. Pain) CNS - dizziness, headache, restless ness, confusion, seizures (rare), Tendon rupture, Phototoxicity, Candida, Risk of CDAD
  8. Pop affected: Older - confusion, somnolence, psychosis, visual dist. Myasthenia gravis
  9. DvD/DvF:
    1. Absorb reduced: Alum and Mag. Antacids, Iron and Zinc Salts, Sucralfate, Milk and Dairy Elevation of Tehopylline (asthma), Warfarin (anticoag), Tinidazole (antifungal)
45
Q

Ofloxacin

A

Class: Fluoroquinolones

46
Q

Moxifloxacin

A

Class: Fluoroquinolones

47
Q

Norfloxacin

A

Class: Fluoroquinolones

48
Q

Levofloxacin

A

Class: Fluoroquinolones

49
Q

Gemifloxacin

A

Class: Fluoroquinolones

50
Q

Metronidazole

A
  1. MOA: Bactericidal
  2. AKA: Flagyl
  3. USEE: Protozoal infections, obligate anaerobes, H.pylori, CDI (CDAD)
  4. ADVERSE: Neurotoxic, Allergy, Superinfections
51
Q

Daptomycin

A
  1. Class: Cyclic Lipopeptide (new)
  2. AKA: Cubicin
  3. MOA: Bactericidal
  4. USE: all Gram +, MRSA
  5. EX: Blood infection with S.aureus, complicated skin/skin related infections by gram +
  6. DvD: none
  7. ADVERSE: muscle injury
  8. Route: IV 1x daily
52
Q

Rifampin

A
  1. Spectrum: Broad
  2. USE: TB, also meningitis (not monotherapy), proph. Of meningitis from Haemophilus influenzae
  3. Can turn urine orange
53
Q

Rifaximin

A
  1. Non absorbable PO form of Rifampin
  2. USE: traveler’s diarrhea OR prevent encephalopath in older patients with chronic liver disease
  3. ADVERSE: N, fart, defecation urgency
54
Q

Bacitracin

A

Route: topical Systemic - could be toxic

55
Q

Polymyxin B

A

Topical - ears, eyes, skin USE: in combo Risk of systemic infection b/c of toxicity

56
Q

Acute Pharyngitis/tonsillitis/Scarlet fever (Sterpococcus pyogenes, supected or proven)

A

1st Choice: Penicillin V or G 2nd Choice: Erythromycin, Clindamycin, Vancomycin, Azithhromycin, daptomycin, linezolid, any cephalosporin ***Most sore throats are viral***

57
Q

Diptheria (corynebacterium diptheriae)

A

1st choice: Erythromycin 2nd choice: Penicillin G ****Antitoxin and supportive treatment are very important (antibiotic 2ndary). Give antibiotic to close contacts and immunize.****

58
Q

Acute Otitis Media and acute sinusitis (Strep pneumoniae, Haemophilus influenzae and Moraxella catarrhalis)

A

1st Choice - Ampicillin, Penicillin G/V or Amox. - Strep Pneumonia, Trimethorprim/Sulfamethoxazole - Haeemophilus influenze 2nd Choice - Strep Pneumonia - cephal., erythromycin, azithromycin, levofloxacin, imipenem, tetracycline, vancomycin Haemophilus Influenza - Cefurxime, amox/clavulanic acid, flouroquinolone ****S. Pneumoniae and H. influenzae in Malaysia = sensitive to ampicillin BUT M.Cattarhalis = resistant to ampicillin***

59
Q

Acutee Epiglottitis (Haemophilus influenzae)

A

1st choice: chloramephenicol 2nd choice: Ampicillin OR 3rd gen. Cephalosporin ****Acute epiglottitis is a medical emergency and requires hospitalization*****

60
Q

Pertusssis (Bordetella pertussis)

A

1st Choice: Erythromycin, Azithromycin, Clarithromycinee 2nd Choice: Trimethorprim/sulfamethoxazole *****Antibiotics don’t do much, but may erradicate oropharyngeal organisms and disrupt transmission*****

61
Q

Acute bronchitis (2ndary bact. Infecition from S.Pneumoniae and Haemophiluss influenzae)

A

1st Choice: Ampicillin S. Pneumonia - Penicillin G/V or Amox. H. influenza - Trimethorprim/sulfamethoxazole 2nd Choice: S. Pneumonia - Cephal., erythromycin, azithromycin, levofloxacin, imipenem, tetracycline, vancomycin H. Influenza - cefurxime, amox/clavulanic, a flouroquinolone ****usually viral = antibiotics not indicated!!! 2ndary BACT. infection may occur in severe cases. IF mycoplasma THEN Erythromycin******

62
Q

Acute Exacerbations of chronic bronchitis (Steptococcus Pneumoniae, H. Influenzae, M. Catarrhalis)

A

1st choice: Ampicillin S. Pneumonia - Peni. G/V or Amox. H. Influenza - Trimethorprim/sulfamethoxazole 2nd choice: S. Pneumonia - Cephalo., Erythro, azithro, levofloxacin, imipenem, tetracycline, vancomycin H. Influenza - Cefurxime, Amox/Clavulanic, a flouroquinolone

63
Q

Pneumonia (Community Acquired mild to moderate) Streptococcus Pneumonaie, Haemophilus Influenzae, Mycoplasm

A

1st Line: Ampicillin OR Strep. Pneumonia - Penicillin G/V or Amoxicillin Haemophilus influenza - Trimethorprim/sulfamethoxazole Mycoplasm - erythromycin, clarithromycin 2nd Line: Strep. Pneumonia: cephalosporin, erythromycin, azithromycin, levofloxacin, imipenem, tetracycline, vancomycin Haemophilus influenza - Cefurxime, amoxicillin/clav. ****When Staph Aureus USE cloxacillin and gentamicin******

64
Q

Acute Urinary Tract infection (E.coli, staphylococcus saprophyticus)

A

1st Line: E. Coli - Cefataxime, ceftazidime, cefepime, ceftriaxone Staphylococcus saprophyticus - Ampicillin, Amoxicillin 2nd Choice: Ecoli - Ampicillin w/or w/o gentamycin, ticarcillin/clav., trimepthroprim/sulfamethoxazole, imipenem, meropenem Staphylococcus Saprophyticus - Nitrfuratoin, a fluoroquinolone, fosfomycin *****Many now resistant to ampicillin. Uncomplicated cystitis in adults = 4 tabs cotrimoxazole in one dose. Pregnant - ampicillin given for 10 days*******

65
Q

Pyelonephritis and complicated UTI (E Coli, other Enterobacteriaceae)

A

1st Line: 2nd Gen. Cephalosporin and Gentamicin, A quinolone

66
Q

Catheter associated infections (Enterbacteriaceae, Pseudomonas and Enterococcus)

A

Treat after culture and sensitivity report Enterobacteriaceae - Imipenem, meropenem, cefepime Pseudomonas - Ciprofloxacin Enterococcus - Ampicillin, Amoxicillin 2nd Line: Enterobacteriaceae - Trimethorprim/sulfamethoxazole, gentamicin, ciprofloxacin, cefotaxime, turcarcillin/clavulanic acid Psuedomonas- Levofloxacin, ceftazidime, cefepime, imipenem, gentamiicin Enterococcus - nitrofurantoin, a fluoroquinolone, fosfomycin

67
Q

Impetigo (Strep pyogenes, Staph aureus)

A

1st Choice: Penicillin G/V 2nd Choice: Clindamycin, vancomycin, erythromycin, daptomycin, linezolid, a cephalosporin

68
Q

Cellulitis (Strep pyogens)

A

1st Line: Penicillin G/V 2nd Choice: Clindamycin, vancomycin, erythromycin, dapto mycin, linezolid, a cephalo.

69
Q

Diabetic Foot Infection (Polymicrobial infection, Enterobacteriaceae, Staph aureus, Strepttococci, Anaerobic bacteria)

A

1st Line: 2nd or 3rd Generation Cephalo and Metronidazole OR Betalactam-Betalactamase inhibitor combination 2nd Choice: Cloxacillin AND Gentamicin AND Metronidazole *****could involve extensive tissue and bone necrosis. Surgical debridement is often needed. Duration of treatement depends on response*****

70
Q

Gingivitis (Spirochaetal, streptococci and oral anaerobes)

A

1st Line: Penicillin V AND metronidazole 2nd Choice: Doxycycline, ceftriaxone

71
Q

Periodontal infections (Strepttococci and oral anaerobes)

A

1st Line: Penicillin G/V 2nd Choice: Erythromycin

72
Q

Anitbiotic Associated Colitis (Clostridium difficile)

A

1st Line: Vancomycin (oral) OR metronidazole

73
Q

MRSA

A

1st Line: Vancomycin w/ or w/o Gentamicin w or w/o Rifampin 2nd Choice: Linezolid, daptomycin, trimethorprim/sulfamethoxazole, a fluoroquinolone

74
Q

Neisseria meningitides (Meningitis)

A

1st Line: Penicillin G 2nd Choice: Cefotaxime, ceftriaxone, chloramphenicol, sulfonamide, a fluoroquinolone

75
Q

Borrelia burgdorferi (Lyme Disease)

A

1st Line: Doxycycline, amoxicillin, cefuroxime 2nd: Ceftriaxone, cefotaxime, penicillin G, azythromycin, clarithromycin

PhArmacology 101 (4 decks)

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