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Pharmacology > Chapter 8: Antimicrobial Therapy > Flashcards

Chapter 8: Antimicrobial Therapy Flashcards

1
Q

In patients being treated with parenteral antibiotic, when is switching to oral indicated

A

Patient is responding to therapy, patient can take oral medications and absorb them, an oral equivalent is available

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2
Q

Endocarditis most likely organism/s

A

Staph aureus

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3
Q

Intrabdominal tissue most likely organism/s

A

E Coli, enterococcus, anaerobes, negative aerobic bacilli

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4
Q

Meningitis <2 months most likely organism/s

A

E coli, Group B strep, listeria

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5
Q

Meningitis 2 month-12 years most likely organism/s

A

Strep pneumoniae, N. meningitidis, H. Influenzae

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6
Q

Meningitis adult most likely organism/s

A

Strep pneumoniae, N. meningitidis

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7
Q

Upper respiratory tract most likely organism/s

A

S. Pneumoniae, H. Influenzae, moreaxella catarrhalis, Group A strep

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8
Q

Lower respiratory tract most likely organism/s

A

S. Pneumoniae, H. Influenzae, M. Catarrhalis, Klebsiella pneumoniae, mycoplasma pneumoniae, c. pneumoniae, viruses

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9
Q

Aspiration pneumonia most likely organism/s

A

Mouth flora

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10
Q

Lower tract hospital acquired most likely organism/s

A

S. Aureus, pseudomonas, other G- aerobic bacilli

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11
Q

Respiratory tract HIV coinfected most likely organism/s

A

Pneumocystis, S. Pneumoniae

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12
Q

Diabetic ulcer most likely organism/s

A

Staph, Strep, G- aerobic bacilli, anaerobes

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13
Q

UTI community most likely organism/s

A

E coli, enterococcus, staph saprophyticus

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14
Q

UTI hospital

A

E coli, enterococcus

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15
Q

Penicilin MOA

A

Bactericidal
Interferes with cell wall synthesis
Inactivates protein binding proteins

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16
Q

Penicilin active against

A

Staph, strep, most enterococcus
No activity against MRSA
DOC G+ infections such as endocarditis

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17
Q

Beta lactamase inhibitors

A

Clavulanic acid, avibactam, sulbactam, tazobactam

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18
Q

Use of beta lactam/beta lactamase inhibitors

A

intraabdominal and gynecological and skin/soft tissue infections, aspiration pneumonia, sinusitis, lung abscesses

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19
Q

Beta lactam/lactamase inhibitors are incompatible with

A

Aminoglycosides

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20
Q

Cephalosporins MOA

A

Bactericidal

Cell wall synthesis inhibition

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21
Q

Progression from 1st to 4th generation cephalosporins

A

Reflects an increase in G- coverage and loss of G+ activity

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22
Q

3rd and 4th cephalosporins can penetrate

A

CSF

Can treat meningitis

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23
Q

1st generation cephalosporins can treat

A

G+ skin infections, pneumoccoal respiratory, UTI, surgical prophylaxis

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24
Q

2nd generation cephalosporins treat

A

Community acquired pneumonia, other respiratory and skin infections

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25
Q

Monobactam agent

A

Aztreonam
Inhibits cell wall synthesis
Bactericidal

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26
Q

Aztreonam is active against

A

G-, including pseudomonas

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27
Q

Aztreonam to treat

A

Complicated and uncomplicated UTI and respiratory tract infections (pneumonia and bronchitis)

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28
Q

Carbapenems

A 
Bactericidal
Most broad spectrum agents available 
Not absorbed orally 
widely distributed with some CSF penetration 
Inhibit cell wall synthesis
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29
Q

Most broad spectrum carbapenems

A

Imipenem, meropenem, doripenem

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30
Q

Carbapenems useful in treating

A

Polymicrobial infections; skin and soft tissue, bone and joint, intrabdominal and lower respiratory tract

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31
Q

What can decrease clearance of meropenem and doripenem

A

Probenecid

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32
Q

Fluoroquinolones

A

-Floxacin
Bactericidal
Inhibits DNA gyrase and topoisomerase IV

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33
Q

Fluoroquinolones have activity against

A

G- aerobic bacteria and some G+

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34
Q

Only oral flouroquinolones active against pseudomonas

A

Ciproflaxacin and levofloxacin

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35
Q

Fluoroquinolones are drug of choice

A

UTI

36
Q

Other uses for fluoroquinolones

A

UTI, pneumonia, STD, skin and soft tissue infections, GI infections, travelers diarrhea, osteomyelitis

37
Q

DOC fluoroquinolone for nosocomial pneumonia

A

Cipro and levofloxacin

38
Q

Cipro metabolism

A

Inhibitor of CYP450 enzyme

39
Q

What can decrease absorption of fluoroquinolones

A

Antacids, sucralfate, magnesium, Ca, Fe

40
Q

If fluoroquinolones are combined with steroids…

A

Risk of tendonitis

41
Q

Prototypical macrolide

A

Erythromycin
Bacteriostatic
Inhibits bacterial protein synthesis by binding to 50S

42
Q

Macrolide that has long half life–can use once daily dosing

A

Azithromycin

43
Q

Macrolides are active against

A

G+ and G- aerobes and atypical organisms–broad spectrum

44
Q

Macrolides used to treat

A

Respiratory tract infections, skin and soft tissue infections, STD, other atypical infections

45
Q

Erythromycin and clarithromycin metabolism

A

Inhibitor of CYP450

46
Q

Aminoglycosides

A

gentomicin, streptomycin
Bacteriostatic
Use and length of therapy is restricted due to drug related toxicities–nephrotoxicity and ototoxicity
Need parenteral administration due to poorly absorbed orally
Inhibit bacterial protein synthesis by binding to 30S

47
Q

Aminoglycosides active against

A

Primarily G- aerobic (E Coli, klebsiella, proteus mirablis, enterobacter, pseudomonas)
Can be active against G+ but must be in combo with cell wall active agent (ampicillin, vanco, nafcillin)

48
Q

Aminoglycosides uses

A

G- infections; neutropenic fever and nosocomial infections
Used in combo to treat pneumonia, bacteremia, intraabdominal and skin/soft tissues
Monotherapy not recommended

49
Q

Streptomycin

A

Aminoglycoside used for TB treatment

50
Q

Other examples of aminoglycosides

A

Gentamicin, tobramycin, amikacin

51
Q

Aminoglycosides may cause

A

Neuromuscular blockade

Ca gluconate will reverse this

52
Q

Tetracyclines

A

Bacteriostatic
Broad spectrum
Have short, intermediate, long acting agents
Best taken on empty stomach
Inhibit protein synthesis by binding to 30S
Used as alternatives if beta lactams not available

53
Q

Tetracyclines examples

A

Doxycycline, demeclocycline, minocycline

54
Q

Uses of tetracyclines

A

Rickettsial, chlamydial, acne, vulgaris, PID

55
Q

DOC for lyme disease

A

Doxycycline

56
Q

Tetracyclines that can treat MRSA

A

Doxycycline and minocycline

57
Q

Dental side effect of tetracyclines

A

brown-gray discoloration of teeth that can be permanent

58
Q

Drug interactions of tetracyclines

A

Divalent/trivalent cations decrease absorption, milk and dairy decrease absorption, can decrease levels of oral contraceptives, increases effect of warfarin

59
Q

Sulfonamides

A

Absorbed in all body fluids and enters CSF, pleural fluid and synovial fluid
Inhibits synthesis of folic acid in bacteria
Usually used in combo with other antibiotics

60
Q

Examples of sulfonamides

A

Suldafiazine, sulfisozazole, trimethoprim

61
Q

Coverage of sulfonamides

A

G+ and G- except pseudomonas and group A strep

62
Q

Bactrim

A

Trimethoprim-Sulfamethoxazole

DOC for treating UTI, PCP, toxoplasmosis

63
Q

Drug interactions of sulfonamides

A

increase effects of warfarin, phenytoin, hypoglycemic agents, methotrexate

64
Q

Glycopeptides

A

Vancomycin
Bactericidal
Narrow spectrum of activity against G+ organisms (MRSA)
Inhibits binding of d-ala-D-ala portion of cell wall precursor

65
Q

DOC for MRSA

A

Vancomycin

66
Q

Other uses of vancomycin

A

Neutropenic fever, endocarditis, meningitis

67
Q

Most common SE vanco

A

fever, chills, phlebitis, red man syndrome (pruritus, flushing, hypotension)

68
Q

Oxazolidinones

A

Linezolid and tedizolid only agents
Binds to 50S
Bacteriostatic
Antagonist of clindamycin

69
Q

Activity of oxazolidinones

A

Active against G+ aerobic, MRSA, VRE, Penicillin resistant strep

70
Q

Clindamycin

A

Bacteriostatic or bactericidal depending on dose
G+ and anaerobic infections
Binds to 50S–similar to macrolides

71
Q

Uses of clindamycin

A

Mixed infections; toxoplasmosis, PCP, PID, toxic shock

72
Q

Main SE of clindamycin

A

Diarrhea and C. Diff colitis

73
Q

Metroniadzole

A

Flagyl
Bactericidal
Inhibits bacterial DNA
DOC for bacterial vaginosis, trich, and C.diff diarrhea

74
Q

What will increase metabolism of metronidazole and cause treatment failure

A

Phenobarb, phenytoin, rifampin

75
Q

Chloramphenicol

A

Bactericidal or bacteriostatic
G+, G-, anaerobic
Binds to 50S subunit
Use limited due to toxic profile–gray baby syndrome, optic neuritis, fatal aplastic anemia

76
Q

Rifampin

A

Decreased RNA synthesis
Bactericidal or bacteriostatic
Active against G+ and some against G-: Neisseria meningitidis, N. gonorrhoeae, and H. Influenzae most sensitive

77
Q

First line agent for TB

A

Rifampin

78
Q

DOC for postexposure meningitis prophylaxis

A

Rifampin

79
Q

SE of rifampin

A

Changes body fluids to red/orange

80
Q

Rifampin metabolism

A

Inducer of CYP

81
Q

Nitrofurantoin

A

Only used for UTI
Bacterial cell wall synthesis interruption through inhibition of several bacterial enzymes
Bacteriostatic or bactericidal depending on dose
Ineffective in patients with renal failure
Should not be used for complicated UTI–pyelonephritis

82
Q

Linezolid SE

A

can cause thrombocytopenia in some patients

Also a mild MAO inhibitor

83
Q

Erythromycin SE

A

Can cause rhabdomyolysis in combination with statins

84
Q

Sulfamethoxazole- Trimethoprim

A

Bactrim
Bacteriostatic
Inhibits dihydrofolate reductase, which inhibits folic acid production in bacteria
Active against staph, strep, and MRSA

85
Q

Streptogramins

A

quinupristin + dalfopristin combo
Bactericidal
Binds to 50S subunit inhibiting protein synthesis
Must be administered IV
Active against staph, strep, enterococcus and MRSA

Pharmacology (56 decks)

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