Antimicrobials Flashcards
class of abx that wors by weakening the organisms cell wall, causing excessive amount of water to be taken up, and rupturing the cell wall, thus disrupting cell wall synthesis and promoting its discretion
Cillins
Coverage of ______:
Gm+
Cillins
\_\_\_\_\_\_ treat: Respiratory GU tract Skin, soft tissue, joints Intra Abdominal infections Prophylactically bacterial endocarditis prevention prior to dental procedure or dental surgery.
Cillins
SE of \_\_\_\_\_\_: nausea, vomiting, diarrhea, abdominal pain, stomach upset, skin rash, hives, itching
Cillins
Interactions of ______:
Oral contraceptives: ↓effectiveness (rare)
Cillins
Interactions of ______:
Methotrexate→ ↑ methotrexate level
Warfarin→ slight ↑ bleed risk
Penicillin
Interactions of ______:
Atenolol: choose different ABT
Allopurinol: avoid
Ampicillin
______ causes rash when used to treat strep throat and mono
Amoxicillin
Contrainidications of ________:
Any person who has a history of type 1 allergic reaction to these drugs
Caution in patients with allergy to cephalosporin
Cillins
Pregnancy/Lactation Considerations for _______:
- Safe in pregnancy and lactation
- Few studies, use only when clearly indicated
- Lacation: low concentrations in milk, may cause diarrhea, candidiasis, or allergic response in infants
Cillins
Pediatric Considerations for _________:
Safety for children < 12 yo not established for carbenicillin and piperacillin-tazobactam
PCN dose adjustments may be required for infants
Cillins
______ are completely safe for use in the elderly.
Penicillins
Class of Abx?
Cefadroxil
Cefazolin
Cephalexin
1st Generation Cephalosporins
Class of Abx that Interfere with cell wall synthesis
Cephalosporins
Coverage of ______:
Gm+ (Strep and Staph but NOT MRSA)
***Enterococcus are resistant
1st Generation Cephalosporins
Coverage of ______:
- Gr+ (but less than 1st gen) & Gm-
- Anaerobes
2nd Generation Cephalosporins
Class of Abx? Cefaclor Cefotetan Cefoxitin Cefproil Cefuroxime Loracarbef
2nd Generation Cephalosporins
Class of Abx? Cefdinir Cefixime Cefotaxime Cefpodoxime Ceftazodine Cefitibuten Ceftriaxone
3rd Generation Cephalosporins
Class of Abx?
Cefepime
4th Generation Cephalosporins
Coverage of ______ + _________:
Gr+ & Gm-
Pseudomonas
3rd Generation Cephalosporins
4th Generation Cephalosporins
SE of _______:
If a patient has a true allergy to PCN, they are more likely to have allergic reaction, particularly 1st generation
Cephalosporins
Interactions of ______:
Probenecid: ↑ and prolong abx plasma levels
Loop diuretics: ↑ nephrotoxicity
Warfarin: ↑ bleed risk
Cephalosporins
Interactions of ______:
ETOH: avoid
Antigoagulants: choose different abx class
Cefotetan <2nd Generation Cephalosporin>
Interaction of ______ (3 drugs):
Antacids: space admin at least 2hr
Cefaclor <2nd Generation Cephalosporin>
Cefdinir + Cefpodoxime <3rd Generation Cephalosporins>
Interaction of ______ :
Iron:space admin at least 2hr
Cefdinir <3rd Generation Cephalosporin>
Contrainidications of ________:
Type 1 Allergy to PCN
Cephalosporins
Contrainidications of ________:
Patients w/ renal impairment
1st Generation Cephalosporins
Contrainidications of ________:
Patients w/ hepatic impairment
Ceftriaxone <2nd Generation Cephalosporin>
Pregnancy/Lactation Considerations for _______:
Safe during pregnancy
Category B, all cross placenta; low presence in breast milk
1st Generation Cephalosporins
Pregnancy/Lactation Considerations for _______:
Reaches therapeutic levels in cord blood
Cefotetan <2nd Generation Cephalosporin>
Pregnancy/Lactation Considerations for _______ (3 drug classes):
Safe
2nd Generation Cephalosporins
3rd Generation Cephalosporins
4th Generation Cephalosporins
Pediatric Considerations for _________:
Not established for infants < 1 month old
Cefazolin <1st Generation Cephalosporin>
Cefaclor <2nd Generation Cephalosporin>
Cefotaxime <3rd Generation Cephalosporin>
Pediatric Considerations for _________:
Varies across generations… more than what’s listed here
Cephalosporins
Pediatric Considerations for _________:
Not established for infants < 2 months old
Cefpodoxime <3rd Generation Cephalosporin>
Pediatric Considerations for _________:
Not established for infants < 3 months old
Cefuroxime <2nd Generation Cephalosporin>
Class of Abx? Ciprofloxacin Levofloxacin Moxifloxacin Norfloxacin Ofloxacin Gemifloxacin
Fluoroquinolones
Class of abx that interfere w/ synthesis and repair enzymes of bacterial DNA so that bacteria can’t reproduce
Fluoroquinolones
class of abx that, when taken PO, are not absorbed well, aren’t highly protein bound, minimally metabolized in the liver, and excreted primarily in urine
Fluoroquinolones
Coverage of _________:
~Narrow spectrum~
Mostly Gm-
Some Gr+
Newer drugs have ↑ activity against Staph, Enterococcus, Strep, DRSP
Atypical organisms: Chlamydia, Legionella, Mycoplasma
Fluoroquinolones
Coverage of ________ :
Anaerobic bacteria
Moxifloxacin (Fluoroquinolone)
SE of \_\_\_\_\_\_\_\_\_: *Tendon Rupture *Tendonitis Dizziness N/V/D Abdominal pain Altered taste Fever Chills Blurred vision Tinnitus Phototoxicity: ranging from mild erythema to severe bullous eruptions in sun- exposed areas Bacterial/fungal overgrowth Severe: diarrhea w/ blood, pus, mucus Rare: CV- Angina, Atrial Flutter, Cardiopulmonary Arrest, Cerebral Thrombosis, MI, Ventricular Ectopy Rare: Acute Renal Failure, Seizures
Fluoroquinolones
Most common SE of _________:
GI symptoms including altered taste
Fluoroquinolones
SE of \_\_\_\_\_\_\_\_\_\_: Acidosis Polyuria Urine retention Calculi
Cipro (Fluoroquinolone)
Interactions of ___________:
Antacids: ↓ GI absorption, ↓ serum levels
Antidiabetics: blood sugar changes
Some antiarrhythmics: risk of serious CV effects, fatal arrhythmias
Glucocorticoids: tendon rupture
Warfarin: ↑ anticoagulant effect
Fluoroquinolones
Interactions of \_\_\_\_\_\_\_\_\_\_\_: Caffeine Phenytoin Probenecid Theophylline
Cipro (Fluoroquinolone)
Interactions of ___________:
NSAIDS
Levofloxacin (Fluoroquinolone)
Interactions of ___________:
Rifampin
Moxifloxacin (Fluoroquinolone)
Interactions of ___________:
Caffeine
Cyclosporine
Nitrofurantoin
Norfloxacin (Fluoroquinolone)
Contraindications for __________:
Patients w/ myasthenia gravis: avoid (tendonitis, tendon rupture)
Patients w/ renal impairment, known or suspected CNS disorders, or predisposed to seizures
First sign of jaundice: Discontinue
Fluoroquinolones
Pregnancy/Lactation Considerations for ___________:
Category C: NOT recommended
No adequate, well-controlled studies
Only use if there is clear benefit that justifies risk to fetus
Lactation: Lower doses (only if no safer alternative)
Fluoroquinolones
Geriatric Considerations for ___________:
High risk for tendonitis and tendon rupture
Increased risk for adverse CNS reactions
Fluoroquinolones
Pediatric Considerations for _________:
Not recommended for children < 18 years old
Only use for complicated UTIs, Pyelonephritis, Post-Anthrax Exposure
Restricted to when there is no safe and effective alternative
Fluoroquinolones
class of abx that inhibit RNA- dependent protein synthesis by acting on small portion of ribosome. They reversibly bind to P site of 50s ribosome. They are distributed to most tissues and body fluids except CSF when meninges are inflamed
Macrolides
______ are acid sensitive so they must be buffered or have enteric coating for PO to prevent destruction by gastric acid
Macrolides
________ are absorbed in the duodenum.
Macrolides
Coverage of _______:
Broad spectrum against Gr(+) and some Gm(-)
PO: Gm(-)
Atypical and intracellular orgs commonly resistant to beta-lactams
Macrolides
_______ is the greatest coverage of the ______ class against Gm(-) and anaerobes
Azythromycin; Macrolides
SE of \_\_\_\_\_\_\_\_\_: ***Overall fewer Epigastric distress N/V/D, diarrhea esp w/ large doses rash fever eosinophilia anaphylaxis reversible hearing loss Fatal hepatotoxicity Potentially fatal exacerbations of myasthenia gravis Visual disturbances
Macrolides
SE of _______:
hepatitis
liver abnormalities
Erythromycin
Azithromycin
Telithromycin
(Macrolides)
SE of _______:
SJ syndrome
skin changes
Erythromycin (Macrolide)
Class of Abx? Erythromycin Azithromycin Fidaxomicin Telithromycin Clarithromycin
Macrolides
SE of _______:
Taste changes
Clarithromycin (Macrolide)
Interactions of \_\_\_\_\_\_\_\_\_: strong CYP450 inhibitors cyclosporine most statins rivaroxaban theophylline carbamazepine select benzos
Increased effect of:
colchicine
digoxin
warfarin
Causes dysrhythmia:
pimozide
tourette tx
Slows absorption:
Antacids with aluminum or magnesium
Macrolides
3 drugs in Macrolide class that have more drug interactions than the others
Erythromycin
Telithromycin
Clarithromycin
Contraindications of ________:
Patients at risk for torsades de pointes
Meds that prolong QT interval
Macrolides
Contraindications of ________:
Not appropriate for treatment of minor upper respiratory infections
Azithromycin
Contraindications of ________:
Pre-existing liver disease
Myasthenia gravis
Erythromycin
Pregnancy Considerations for Macrolides:
_______ + ________ are safe, Category B
Erythromycin
Azithromycin
Lactation Considerations for Macrolides:
(3) drugs are compatible with breastfeeding
Caution w/ other meds in class due to few studies
Erythromycin
Azithromycin
Clarithromycin
Pregnancy Considerations for Macrolides:
(2) drugs have adverse effects on fetal development, Category C
Telithromycin
Clarithromycin
Macrolide that is safe for infants and children
Erythromycin
Macrolide that is safe for children as young as 6 mos for otitis media, sinusitis, CA
and children > 2 yo for pharyngitis and tonsillitis
Azithromycin
Macrolide that is safe for children > 6 mo
Clarithromycin
Macrolide that safety is not established for children < 12 yo
Dirithromycin
Macrolide that safety is not established for children
Telithromycin
Geriatric Considerations for ________:
No specific dosage adjustments or precautions recommended w/ normal renal and hepatic function
*WIth impairment, treat as you would other patients w/ no additional precautions
Macrolides
Class of Abx? Minocycline Tetracycline Doxycycline Tigecycline Demeclocycline
Tetracyclines
Class of abx that inhibit growth or multiplication of bacteria by penetrating bacterial cell
(Bacteriostatic) Tetracyclines
Class of abx that work on highly susceptible organisms and high concentrations by binding primarily to subunit of the ribosome causing protein synthesis inhibition
Reversibly to 30S
(Bactericidal) Tetracyclines
Coverage of \_\_\_\_\_\_\_\_: Broad Gr+ and Gm- Also... aerobic anaerobic spirochetes mycoplasmas rickettsiae chlamydiae gonorrhea some protozoa MRSA
Tetracyclines
SE of \_\_\_\_\_\_\_: N/V/D photosensitivity abdominal distress/distention Teeth: discoloration, enamel hypoplasia Severe: hepatic and renal toxivity Decreased oral contraceptive effectiveness
Tetracyclines
SE of \_\_\_\_\_\_ (Tetracycline): lightheadedness dizziness vertigo vestibular reactions
Minocycline
SE of ______ (Tetracycline):
fatty infiltration of the liver
Tetracyclines
Interactions of _________:
Best to avoid calcium/iron or take >2 hours apart: Milk products- space 1-2 hrs after meals
Tetracyclines EXCEPT Minocycline and Doxycycline
Interactions of __________:
aluminum, magnesium, calcium (↓ PO absorption)
Oral contraceptives
Tetracyclines
Interactions of \_\_\_\_\_\_\_\_\_\_: iron salts bismuth zinc sulfate (space dosing) (All of these decrease absorption of 2 drugs in this class)
Tetracycline
Doxycycline
Interactions of \_\_\_\_\_\_\_\_\_\_: barbiturates carbamezepine phenytoin ETOH (All of these increase metabolism and decrease effect of 1 drug in this class)
Doxycycline (Tetracycline)
Contraindications of __________:
Pregnancy
Children up to 8 yo: binds to calcium in bones and teeth → yellow or brown discoloration and hypoplasia of tooth enamel
Premies: suppresses long bone growth
Caution in patients w/ renal and hepatic impairment
Tetracyclines
Pregnancy Considerations for ________:
!!Contraindicated!!
Cat X, should not be used in pregnancy
*Cross placenta w/concentration up to 60%
Tetracyclines
Lactation Considerations for __________:
Excreted in breastmilk
AAP consideres it compatible b/c serum concentrations below detectable level
Tetracyclines
Tetracycline that may affect breast milk production or composition
Minocycline
Only Tetracycline that is Cat D, not Cat X
Doxycycline
Pediatric Considerations for ___________:
Do not give to children < 8 yo
Do not give to premies (suppresses long bone growth)
Tetracyclines
In pediatric patients, the tetracycline less likely to harm but risks outweigh benefits for most indications
Doxycycline
Geriatric Considerations for _________:
None, safe to Rx
Tetracyclines
Class of Abx? Sulfadiazine Sulfamethoxazole Sulfamethoxazole/trimethoprim (Bactrim) Sulfisoxazole Sulfasalazine
Sulfanomides
