Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

APhA Naplex > Ch34 Anti-infective Agents > Flashcards

Ch34 Anti-infective Agents Flashcards

1
Q

What is the general spectrum of aminoglycosides? (2)

A
  1. Gram (-)

2. Select aerobic gram (+)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the mechanism for aminoglycosides? (2)

A
  1. Inhibit protein synthesis through binding to the 30S ribosomal subunit “3 (common aminoglycosides) 30S”
  2. This irreversibly inhibits bacterial RNA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Are aminoglycosides bactericidal or bacteriostatic?

A

Bactericidal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which aminoglycosides are minimally absorbed and are used to decrease bacterial content in the bowel? (2)

A
  1. Kanamycin

2. Neomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are important ADRs of aminoglycosides? (3)

A
  1. Nephrotoxicity
  2. Ototoxicity
  3. Neuromuscular blockade
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are risk factors for neuromuscular blockade caused by aminoglycosidses? (3)

A
  1. Myasthenia gravis
  2. Hypocalcemia
  3. Elevated peak concentrations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What nerve is damaged in aminoglycoside induced ototoxicity?

A

Eighth cranial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How are aminoglycosides dosed?

A
  1. Actual body weight

2. Unless patient is obese 20% over ideal use adjusted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the equation for ideal body weight (only needed for aminoglycosides to calculate adjusted if obese)?

A

Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet.
Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet.
1. My ideal 6ft = 77.6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the equation for adjusted body weight?

A

IBW + 0.4(total body weight - ideal)

Ideal is on the outsides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the target serum concentrations for amikacin?

A
  1. Peak = 20-30mcg/ml

2. Trough = <10 mcg/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the target serum concentrations for gentamicin and tobramycin?

A
  1. Peak = 4-10mcg/ml

2. Trough = <2mcg/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which aminoglycoside can be inhaled via nebulization?

A

Tobramycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the rationale for extended interval dosing with aminoglycosides? What trait is helpful in this dosing?

A
  1. Designed to drive the peak very high to max the concentration dependent killing and allow troughs to fall to reduce toxicity
  2. They have a significant postantibiotic effect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the mechanism of penicillins?

A

Bind to penicillin binding protein in cell wall

Cell wall synthesis is inhibited

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Are penicillins bactericidal or bacteriostatic?

A

Bactericidal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does the chemical structure of penicillins consist of?

A
  1. Beta-lactam

2. Thiazolidine Ring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How are penicillins eliminated? Name two exceptions.

A
  1. Renal

2. Nafcillin and oxacillin are hepatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are examples of “natural penicillins?” (2)

A
  1. Penicillin G

2. Penicillin V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are examples of “penicillinase-resistant penicillins?” (4)

A
  1. Oxacillin
  2. Nafcillin
  3. Cloxacillin
  4. Dicloxacillin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are examples of penicillin + beta lactamase inhibitors? (4)

A
  1. Amoxicillin Clavulanic acid (Augmentin)
  2. Ticarcillin Clavulanic acid (Timentin)
  3. Ampicillin Sulbactacm (Unasyn)
  4. Piperacillin Tazobactam (Zosyn)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the spectrum of natural penicillins? (5)

A
  1. Viridans Streptococci
  2. Streptococcus pyogenes
  3. 60% Streptococcus Pneumoniae
  4. Clostridium Pefringens (gas gangrene)
  5. Mouth anaerobes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What bacteria are natural penicillins ineffective against?

A

Staphylococcus aureus (penicillinase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What do aminopenicillins have greater penetration for and higher affinity for?

A
  1. The outer membrane of gram (-) rods

2. Penicillin binding proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Are cephalosporins bactericidal or bacteriostatic?

A

Bactericidal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the mechanism of cephalosporins?

A
  1. Inhibit mucopeptide synthesis in the bacterial cell wall

2. Formation of defective cell walls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is a common dose for penicillin G benzathine (Bicillin LA)? For syphilis treatment?

A
  1. 2 million units IM single dose

2. 4 million units IM single dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the first generation cephalosporins? (3)

A
  1. Cephalexin (Keflex) po
  2. Cefadroxil (Duricef) po
  3. Cefazolin (Ancef) IV”
    ALEX tried to keep up with the FADs but they FAZzled out”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the general spectrum for first generation cephalosporins?

A

More gram (+) than gram negative coverage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the second generation cephalosporins? (5)

A
  1. Cefaclor (Ceclor) po
  2. Cefuroxime (Ceftin, Zinacef) IV IM po
  3. Cefoxitin (Mefoxin) IV
  4. Cefotetan (Cefotan) IV IM
  5. Cefprozil (Cefzil) po
    “The FACt is the FURry FOX crossed the TETANs like a PRO”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the general spectrum for second generation cephalosporins?

A

Enhanced gram (-) over 1st gen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the third generation cephalosporins? (7)

A
  1. Cefpodoxime (Vantin) po
  2. Ceftazidime (Fortaz, Tazicef) IV IM
  3. Cefixime (Suprax) po
  4. Cefdinir (Omnicef) po
  5. Ceftriaxone (Rocephin) IV IM
  6. Cefibuten (Cedax) po
  7. Cefotaxime (Claforan) IV
    “Listening to his iPOD, TAZ was so FIXed on DINIR he fell off his TRIke onto his BUT and had to pay TAXes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the general spectrum for third generation cephalosporins?

A
  1. More gram (-) than positive coverage

2. Cerebrospinal fluid penetration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the general spectrum for third generation cephalosporins?

A
  1. More gram (-) than positive coverage

2. Cerebrospinal fluid penetration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the fourth generation cephalosporin?

A

Cefepime (Maxipime) IV IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the fifth generation cephalosporin?

A

Ceftaroline (Teflaro) IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What cephalosporins have antipseudomonal activity?

A
  1. Ceftazidime

2. Cefepime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Which cephalosporin has no gram (+) activity?

A

Ceftazidime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What cephalosporins have anaerobic coverage? (4)

A

Cefotetan 2nd
Cefoxitin 2nd
Cefprozil 2nd
Cefpodoxime 3rd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Which cephalosporin has bleeding (hypoprothrombinemia) which is attributable to the presence of a N-methylthiotetrazole side chain?

A

Cefotetan

41
Q

What cephalosporin can cause a disulfiram-like reaction with ingestion of alcohol?

A

Cefotetan

42
Q

Which cephalosporins should be adjusted in renal insufficiency?

A

All but ceftriaxone (renal and via bile cleared)

43
Q

What mechanism can cause bacterial resistance to cephalosporins?

A

Beta-lactamases

44
Q

Are carbapenems beta-lactams?

A

They are beta-lactam-like

Structurally similar to penicillins

45
Q

What is the mechanism for carbapenems?

A

Bind to penicillin binding proteins and inhibit peptidoglycan synthesis

46
Q

Carbapenems are the DOC for what?

A

ESBL producing Enterobacteriaceae species

47
Q

What is ESBL?

A

Extended Spectrum Beta-Lactamases

48
Q

What is the general spectrum for carbapenems? (5)

A
  1. Gram (+)
  2. Gram (-)
  3. Anaerobes
  4. Atypical (Mycobacterium and chlamydia)
  5. Pseudomonas Acinetobacter (not ertapenem)
49
Q

What are the most common ADRs reported with imipenem? (2)

A
  1. GI NVD (C.diff)

2. Seizures reported in 0.4%

50
Q

Why is cilastatin needed with imipenem?

A

It increases the AUC and urinary concentrations of imipenem

51
Q

What is a difference in ADRs of meropenem and doripenem compared to imipenem?

A

Meropenem and doripenem have decreased CNS toxicity

52
Q

What is a common dose for ertapenem?

A

1000 mg q24h

53
Q

What type of bacterial killing do aminoglycosides have?

A

Concentration dependent

54
Q

What type of bacterial killing do penicillins and cephalosporins have?

A

Time above the MIC dependent

55
Q

What type of bacterial killing do fluoroquinolones have?

A

Concentration dependent

56
Q

What condition cannot be treated with daptomycin?

A

Pneumonia

57
Q

What condition should not be treated with linezolid?

A

Endovascular infections

58
Q

What is the spectrum of clindamycin?

A

Anaerobes
Gram (+)
MRSA

59
Q

What conditions are tetracyclines the DOC for? (2)

A
  1. Lyme disease

2. Rocky Mountain spotted fever

60
Q

What is the general spectrum for macrolides?

A
  1. Gram (+)

2. Atypical

61
Q

What is a BBW for telithromycin?

A

Hepatotoxicity

62
Q

Why is aztreonam less likely to have cross-reactivity with penicillin allergy?

A

It does not have a beta lactam ring

63
Q

What is the spectrum for aztreonam?

A

Gram (-)

64
Q

Name two bacteria that linezolid is active against?

A

Enterococcus faceium and faecalis

65
Q

What are some serious ADRs to linezolid? (3)

A
  1. Myelosuppression
  2. Neurotoxicity (peripheral neuropathy, and optic neuritis)
  3. Lactic Acidosis
66
Q

When are myelosuppression ADRs to linezolid more common to occur?

A

When therapy exceeds 14 days

67
Q

What is an important drug interaction with linezolid? (4 classes, 1 agent involved)

A
  1. It is a weak MAO inhibitor

2. Caution with Sympathomimetics (Pseudoephedrine, NE, DA), SSRIs, TCAs, Triptans, Meperidine)

68
Q

Where does linezolid achieve higher concentrations (tissue vs plasma)?

A

In tissue rather than plasma

69
Q

What is the mechanism of daptomycin?

A
  1. Causes rapid depolarization to bacterial cell membranes “rap depo dapto anagramish”
  2. Loss of membrane potential inhibits protein, DNA, and RNA synthesis
70
Q

What are 2 serious ADRs with daptomycin?

A
  1. Rhabdomyolysis (increased creatine phosphokinase)

2. Nephrotoxicity

71
Q

What is the dose for daptomycin in treating pneumonia?

A

It cannot be used. It is inactivated by the surfactant in the lung

72
Q

What is the mechanism of vancomycin? (2)

A
  1. Inhibition of peptidoglycan synthesis polymerization and cross-linking
  2. May also inhibit RNA synthesis
73
Q

What is “red-man syndrome”?

A

Caused my histamine release associated with rapid IV infusion of vancomycin

74
Q

How can the risk of “red-man syndrome be minimized?

A
  1. Slow IV infusion of vancomycin

2. NTE 500mg/30 mins

75
Q

What is the volume of distribution of vancomycin?

A

0.7 L/kg (total body weight)

76
Q

Are fluoroquinolones bactericidal or bacteriostatic?

A

Bactericidal

77
Q

What is the mechanism of fluoroquinolones?

A

Inhibition of bacterial DNA gyrase and topoisomerase

78
Q

What is an important counseling point fluoroquinolones

A
  1. Ca, Mg, iron decrease absorption

2. Antacids, dairy, and multivitamins should not be taken for at least 2 hours after dose

79
Q

What is a BBW for fluoroquinolones?

A
  1. Increased risk of tendinitis and tendon rupture (increased risk >60 years, children)
  2. Avoid in myasthenia gravis
80
Q

Are macrolides bactericidal or bacteriostatic?

A

Bacteriostatic

81
Q

What is the mechanism for macrolides?

A

Bind to 50S RNA subunit thereby inhibiting RNA synthesis

82
Q

What is the PO to IV conversion of azithromycin?

A

Equal

83
Q

Macrolides are the DOC in what diseases? (2)

A
  1. Atypical pneumonia

2. Chlamydia

84
Q

What is the difference between tetracyclines and tigecycline?

A

Same MOA but tigecycline has a structural modification that increases affinity and binding to the bacterial ribosome and decreases efflux from the cell

85
Q

What are counseling points for tetracycline?

A
  1. Best to take without food. Food interferes with absorption. However, food can minimize GI ADRs
  2. Photosensitivity
  3. Antacids, Dairy, Iron, Multivitamin should be avoided for several hours before and after (decrease tetracycline concentration)
86
Q

What is an important serious ADR for sulfamethoxazole?

A

Dermatologic reactions (Steven-Johnson syndrome, rash, urticaria)

87
Q

What antibiotic can induce clostridium difficile enterocolitis at higher rates?

A

Clindamycin

88
Q

What miscellaneous antibiotic causes a disulfiram-like reaction?

A
  1. Metronidazole

2. Alcohol should be avoided 3 days before and after

89
Q

What should be considered as an alternative to ceftriaxone in treating meningitis in patients with a life threatening b-lactam allergy? Why

A
  1. Chloramphenicol

2. It penetrates CNS

90
Q

What is the mechanism which explains why chloramphenicol has limited use?

A

It’s toxicities are caused by inhibition of mammalian protein synthesis

91
Q

What is the BBW for chloramphenicol? (3)

A
  1. Can cause life-threatening blood dyscrasias (abnormal blood condition)
  2. Aplastic anemia (bone marrow does not produce sufficient new blood cells) and Hypoplastic anemia (decreased RBCs)
  3. Thrombocytopenia and granulocytopenia
92
Q

What agent can cause gray baby syndrome?

A

Chloramphenicol

93
Q

What are the components of prokaryotic ribosomes? (3)

A
  1. 70S
  2. Large subunit = 50S (5S, 23S)
  3. Small subunit = 30S (16S)
94
Q

What are two indications for rifaximin?

A
  1. Traveler’s diarrhea caused by E coli

2. Hepatic encephalopathy

95
Q

What are three examples of echinocandins?

A
  1. Caspofungin
  2. Micafungin
  3. Andulafungin
96
Q

When should caspofungin be dose adjusted?

A

Severe liver dysfunction

97
Q

Are azole antifungals inducers or inhibitors of CYP?

A

Inhibitor

98
Q

What is a cardiovascular ADR of azole antifungals?

A

QT prolongation

APhA Naplex (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions