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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
Monobactam agent
Aztreonam Inhibits cell wall synthesis Bactericidal
26
Aztreonam is active against
G-, including pseudomonas
27
Aztreonam to treat
Complicated and uncomplicated UTI and respiratory tract infections (pneumonia and bronchitis)
28
Carbapenems
``` Bactericidal Most broad spectrum agents available Not absorbed orally widely distributed with some CSF penetration Inhibit cell wall synthesis ```
29
Most broad spectrum carbapenems
Imipenem, meropenem, doripenem
30
Carbapenems useful in treating
Polymicrobial infections; skin and soft tissue, bone and joint, intrabdominal and lower respiratory tract
31
What can decrease clearance of meropenem and doripenem
Probenecid
32
Fluoroquinolones
-Floxacin Bactericidal Inhibits DNA gyrase and topoisomerase IV
33
Fluoroquinolones have activity against
G- aerobic bacteria and some G+
34
Only oral flouroquinolones active against pseudomonas
Ciproflaxacin and levofloxacin
35
Fluoroquinolones are drug of choice
UTI
36
Other uses for fluoroquinolones
UTI, pneumonia, STD, skin and soft tissue infections, GI infections, travelers diarrhea, osteomyelitis
37
DOC fluoroquinolone for nosocomial pneumonia
Cipro and levofloxacin
38
Cipro metabolism
Inhibitor of CYP450 enzyme
39
What can decrease absorption of fluoroquinolones
Antacids, sucralfate, magnesium, Ca, Fe
40
If fluoroquinolones are combined with steroids...
Risk of tendonitis
41
Prototypical macrolide
Erythromycin Bacteriostatic Inhibits bacterial protein synthesis by binding to 50S
42
Macrolide that has long half life--can use once daily dosing
Azithromycin
43
Macrolides are active against
G+ and G- aerobes and atypical organisms--broad spectrum
44
Macrolides used to treat
Respiratory tract infections, skin and soft tissue infections, STD, other atypical infections
45
Erythromycin and clarithromycin metabolism
Inhibitor of CYP450
46
Aminoglycosides
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
Aminoglycosides active against
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
Aminoglycosides uses
G- infections; neutropenic fever and nosocomial infections Used in combo to treat pneumonia, bacteremia, intraabdominal and skin/soft tissues Monotherapy not recommended
49
Streptomycin
Aminoglycoside used for TB treatment
50
Other examples of aminoglycosides
Gentamicin, tobramycin, amikacin
51
Aminoglycosides may cause
Neuromuscular blockade | Ca gluconate will reverse this
52
Tetracyclines
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
Tetracyclines examples
Doxycycline, demeclocycline, minocycline
54
Uses of tetracyclines
Rickettsial, chlamydial, acne, vulgaris, PID
55
DOC for lyme disease
Doxycycline
56
Tetracyclines that can treat MRSA
Doxycycline and minocycline
57
Dental side effect of tetracyclines
brown-gray discoloration of teeth that can be permanent
58
Drug interactions of tetracyclines
Divalent/trivalent cations decrease absorption, milk and dairy decrease absorption, can decrease levels of oral contraceptives, increases effect of warfarin
59
Sulfonamides
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
Examples of sulfonamides
Suldafiazine, sulfisozazole, trimethoprim
61
Coverage of sulfonamides
G+ and G- except pseudomonas and group A strep
62
Bactrim
Trimethoprim-Sulfamethoxazole | DOC for treating UTI, PCP, toxoplasmosis
63
Drug interactions of sulfonamides
increase effects of warfarin, phenytoin, hypoglycemic agents, methotrexate
64
Glycopeptides
Vancomycin Bactericidal Narrow spectrum of activity against G+ organisms (MRSA) Inhibits binding of d-ala-D-ala portion of cell wall precursor
65
DOC for MRSA
Vancomycin
66
Other uses of vancomycin
Neutropenic fever, endocarditis, meningitis
67
Most common SE vanco
fever, chills, phlebitis, red man syndrome (pruritus, flushing, hypotension)
68
Oxazolidinones
Linezolid and tedizolid only agents Binds to 50S Bacteriostatic Antagonist of clindamycin
69
Activity of oxazolidinones
Active against G+ aerobic, MRSA, VRE, Penicillin resistant strep
70
Clindamycin
Bacteriostatic or bactericidal depending on dose G+ and anaerobic infections Binds to 50S--similar to macrolides
71
Uses of clindamycin
Mixed infections; toxoplasmosis, PCP, PID, toxic shock
72
Main SE of clindamycin
Diarrhea and C. Diff colitis
73
Metroniadzole
Flagyl Bactericidal Inhibits bacterial DNA DOC for bacterial vaginosis, trich, and C.diff diarrhea
74
What will increase metabolism of metronidazole and cause treatment failure
Phenobarb, phenytoin, rifampin
75
Chloramphenicol
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
Rifampin
Decreased RNA synthesis Bactericidal or bacteriostatic Active against G+ and some against G-: Neisseria meningitidis, N. gonorrhoeae, and H. Influenzae most sensitive
77
First line agent for TB
Rifampin
78
DOC for postexposure meningitis prophylaxis
Rifampin
79
SE of rifampin
Changes body fluids to red/orange
80
Rifampin metabolism
Inducer of CYP
81
Nitrofurantoin
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
Linezolid SE
can cause thrombocytopenia in some patients | Also a mild MAO inhibitor
83
Erythromycin SE
Can cause rhabdomyolysis in combination with statins
84
Sulfamethoxazole- Trimethoprim
Bactrim Bacteriostatic Inhibits dihydrofolate reductase, which inhibits folic acid production in bacteria Active against staph, strep, and MRSA
85
Streptogramins
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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