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DD and BL (MHO) > DD Antimicrobials Brainscape > Flashcards

DD Antimicrobials Brainscape Flashcards

1
Q

Penicillins- MOA, E, Adverse Rxns

A

c.w. synthesis inhibition (III) bactericidal), renal, anaphylaxis (Type I, rare) and rash (more common)

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2
Q

Penicillin G- A, Spectrum and Uses, Adverse Reactions

A

IM/IV (poor oral), Narrow spectrum: Cocci gram + (Staph, Strep, and Entero), Cocci gram - (Neisseria), Anaerobes (most, but NOT bacterides), convulsions at very high doses

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3
Q

Penicillin V- A, Spectrum and Uses, Adverse Reactions

A

good oral, Narrow spectrum- Cocci gram + (Staph, Strep, and Entero), Cocci gram - (Neisseria), Anaerobes (most, but NOT bacterides), cinvulsions at high doses

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4
Q

Oxacillin, Dicloxacillin, Methicillin, Nafcillin- A, Spectrum and Uses

A

good oral (except meth and naf), penicillinase resistant: penicillinase producing S. aureus (MSSA) and skin infections (NOT MRSA)

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5
Q

Other PCN penicilinase susceptible or resistant?

A

Susceptible; unless combined w/ B lactamase inhibitor such as amoxicillin-clavulanate.

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6
Q

Amoxicillin and Ampicillin- A, Spectrum and Uses, Adverse Rxns

A

good oral, Extended Spectrum: Rods gram - (E.coli, H. flu, Proteus), Cocci gram + (less than Pen G/V), diarrhea (less w/ amoxiciilin) and superinfection possible

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7
Q

Pipercillin + B lactamase inhibitor- A, Spectrum and Uses

A

IV only, Antipseudomonal: Pseudomonas and Bacteriodes (+other anaerobes) (Amox/Clav also Bacteriodes)

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8
Q

Cephalosporins- MOA, E, Spectrum and Uses, Adverse Reactions

A

c.w. synthesis inhibition (III) bactericidal, renal excretion (almost all), Extended spectrum: NOT susceptible to pencillinases (NSBL) and some gram neg, allergy, less severe than penicillins (some cross sensitivity ~1.5%)

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9
Q

Cephalexin and Cefazolin (1st Gen)- A, Spectrum and Uses, Adverse Rxns

A

Good oral (cefalexin) and IV/IM only (cefazolin), cocci gram +, rods gram- (Proteus, E.coli, Kleibsiella) (similar to amoxicillin), diarrhea

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10
Q

Cefaclor/ Cefuroxime, Cefoxitin (2nd gen)- A, Spectrum/Uses, Adverse Rxns

A

good oral (cefaclor/ceuroxime), IM/IV (cefoxitin), Rods: gram - (H.flu, Enterobacter), Bacteriodes (+ other anerobes), DDI: enhancement of warfarin, superinfection possible

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11
Q

Cefdinir and Ceftriaxone (3rd gen) and Cefepime (4th)- A, Spectrum/Uses, Adverse Rxns

A

good oral (cefdinir), IV/ IM (cetriaxone), both with good CNS penetration, Rods: expanded gram-, good gram + cocci for cetriaxone, moderate antipseudomonal activity, superinfection possible

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12
Q

What are the 1st, 2nd, and 3rd generation of Cephalosporins?

A

1st: cephalexIN and cephazolIN, 2nd: Cefaclor/ Cefuroxime, and Cefoxitin, 3rd: Cefdinir and Ceftriaxone

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13
Q

Vancomycin- MOA, A, E, Spectrum/Uses, Adverse Rxns

A

c.w. synthesis inhibition (Stage II) bactericidal, IV only (poor absorption), renal excretion, narrow spectrum: cocci gram+, active against MRSA and enterococci, anaerobes: C. difficile, Terrible at gram - rods, Infusion related problems (chills, fever, rash), ototoxicity, renal toxicity (need routine monitoring of Cp levels)

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14
Q

Carbapenems (Imi-, mero-, dori-, and ertapenum) - MOA, A, E, Spectrum/Uses, Adverse Rxns

A

c.w. synthesis inhibition (Stage III) bactericidal, IV only, renal excretion, once daily for Ertapenum, wide spectrum (reserved for multidrug resistant organisms) Imi, mero, dori tx pseudomonas), nausea, vomiting, diarrhea, seizures possible at highest doses

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15
Q

Macrolides-MOA, A, D, E, Spectrum/Uses, Adverse Rxns

A

protein synthesis inhibtion (50S), bacteriostatic, good oral (also IV), concentrates in lungs, extended spectrum: cocci/rods: gram + anerobes (alternative if PCN allergy), Atypical (Mycoplasma, chlamydia) GI disturbances (n/v, diarrhea, ERY > CLA-AZI), DDI due to inhibition of CYP450 (not AZI)

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16
Q

What are three types of macrolides?

A

Erythromycin, Azithromycin, Clarithromycin

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17
Q

Erythromycin- A, E

A

QID (4x/day), liver metabolism

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18
Q

Azithromycin- A, E

A

QD, biliary

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19
Q

Clarithromycin

A

BID (2x/day) meatbolism to active metabolite

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20
Q

Tetracyclines- MOA, Spectrum and Uses, Adverse Reactions

A

protein synthesis inhibition (30S), static, broad spectrum BUT many gram +/- organisms now resistant, choice in CA-MRSA, Atypical: chlamydia and mycoplasma. , abnormal bone and tooth development (avoid in preg and <8y/o) n/v/diarrhea, fungal superinfection, DDI w/ metal cations (Antacids/ dairy/ iron) in stomach.

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21
Q

Doxycyline- A, E

A

po, biliary

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22
Q

Clindamycin- MOA, A, D, E, Spectrum/Uses, Adverse Rxns

A

Protein synthesis inhibition (50S), bacteriostatic, good po (also IV), penetrates into bone, hepatobiliary elimination, narrow spectrum: gram + cocci (PCN Alternative), anaerobes (NOT C diff, acne, choice in CA-MRSA), severe diarrhea, pseudomembranous colitis

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23
Q

Aminoglycosides (Tobra-, genta-, neo-, streptomycin)- MOA, A, D, E, Spectrum/Uses, Adverse Rxns

A

protein synthesis (30S), bactericidal, poor oral absorption (IV/IM), distrubuted in extracellular fluid, accumulates in kidney and ear, renal excretion, narrow spectrum: gram- aerobes (E.coli, Pseudomonas), bowel sterilization presurgery (Neo), Tuberculosis (Strepto), vestibular and auditory toxicity, nephrotoxicity (routine monitioring of Cp levels)

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24
Q

Fluoroquinolones- MOA, A, Spectrum/Uses, Adverse Rxns

A

Inhibition of DNA gyrase, bactericidal, good oral (also IV), extended spectrum, well tolerated, some GI upset, superinfections, possible DDI w/ theophylline (decrease metabolism) and antacids (decrease absorption), rare: CNS disorders, NOT 1st choice in children)

25
Q

What are the 2nd, 3rd, and 4th generations of Fluoroquinolone?

A

Ciprofloxaxin, Levofloxacin, Moxifloxacin

26
Q

Ciprofloxacin (2nd gen FQ)- E, Spectrum and Uses

A

primarily renal excretion –> excellent G- (Pseudomonas, UTIs)

27
Q

Levofloxaxin (3rd gen FQ)- E, Spectrum and Uses

A

primarily renal excretion, Excellent gram +/- (respiratory, UTIs)

28
Q

Moxifloxaxin (4th gen FQ)- E, Spectrum and Uses

A

primarily hepatic (20% renal), excellent gram +/- (respiratory plus some anaerobes/ atypical)

29
Q

Nitrofurantoin- MOA, A, E, Spectrum/Uses, Adverse Rxns

A

reduced in cell to intermediates that damage DNA, cidal, rapid, complete GI absorption, but rapid complete excretion via kidneys, thus acts as urinary antiseptic, 1st line agent in UTIs if TMP-SMX resistant E.coli, GI side effects, macrocrystalline forms better tolerated. (gram- rods

30
Q

Metronidazole- MOA, A, E, Spectrum/Uses, Adverse Rxns

A

reduced intracellularly to active form; interference with DNA fxn bactericidal, good oral bioavailability,hepatic metabolism, anerobicbacteria (Cdifficile), protozoa, nausea, headache, GI distress, antaabuse-like reaction, occasional candidal superinfection

31
Q

Antibiotics Sensitive/ Resistant to Streptococcus pyogenes

A

Sensitive: Macrolides and Clindamycin

32
Q

Antibiotics Sensitive/ Resistant to Viridans strep

A

Sensitive: Clindamycin

33
Q

Antibiotics Sensitive/ Resistant to MSSA (S. aureus)

A

Sensitive: Dicloxacillin, Amox/Clav, Pip/Tazo, all Cephasporins (+/- with Ceftazidime 3rd gen), all carbapenems, +/- with Clindamycin

34
Q

Antibiotics Sensitive/ Resistant to MRSA (S. aureus)

A

Sensitive: Vancomycin, and +/- Clindamycin, Resistant: all penicillins, all cephalosporin, all carbapenems

35
Q

Antibiotics Sensitive/ Resistant to Enterococcus

A

Sensitive: Penicillin, Amoxicillin/Ampicillin, Vancomycin

36
Q

Antibiotics Sensitive/ Resistant to VRE

A

Resistant: Vancomycin

37
Q

Antibiotics Sensitive/ Resistant to Neisseria gonorrhoeae

A

Sensitive: Ceftriaxone (3rd), +/- macrolides and tetracyclines

38
Q

Antibiotics Sensitive/ Resistant to E.coli

A

Sensitive: Amoxicillin/Ampicillin, AmoxClav, Pip/Tazo, Aminoglycosides, Nitrofurantoin

39
Q

Antibiotics Sensitive/ Resistant to E. coli (TEM-1)

A

Sensitive: Amox/Clac, Pip/Tazo, Aminoglycosides, and Nitrofurantoin. Resistant: Amoxicillin/Ampicillin

40
Q

Antibiotics Sensitive/ Resistant to E. coli (ESBL, extended specrum B-lactamase)

A

Sensitive: Aminoglycosides. Resistant: all cephalosporins

41
Q

Antibiotics Sensitive/ Resistant to Klebsiella (SHV-1)

A

Sensitive: Amox/Clav, Pip/Tazo, and Aminoglycosides. Resistant: Amoxicillin/Ampicillin

42
Q

Antibiotics Sensitive/ Resistant to Klebsiella (KPC)

A

Sensitive: +/- to Aminoglycosides. Resistant: all Carbapenems

43
Q

Antibiotics Sensitive/ Resistant to Pseudomonas

A

Sensitive: Pip/Tazo, Ceftazidime (3rd gen), Cefepime (4th gen), Imi/Dori, Meropenem, Ags, Ciprofloxacin and Levofloxacin. Resistant: Ertapenem, Moxifloxacin

44
Q

Antibiotics Sensitive/ Resistant to Clostridium difficile

A

Sensitive:Vancomycin (oral) and Metronidazole

45
Q

Antibiotics Sensitive/ Resistant to Bacteroides fragilis

A

Sensitive: Amox/Clav, Pip/Tazo, Carbapenems, Metronidazole, +/- Clindamycin

46
Q

Antibiotics Sensitive/ Resistant to Chlamydia

A

Sensitive: Macrolides, Tetracycline, all FQs.

47
Q

Antibiotics Sensitive/ Resistant to Mycoplasma

A

Sensitive: Macrolides, Tetracycline, all FQs.

48
Q

Drug Classes Eliminated by Renal Excretion

A

Penicillins, Cephalosporins, Vancomycin, Aminoglycosides, Fluoroquinolones; all require dosage adjusments if renal impairment.

49
Q

Drug Classes Eliminated by Non-Renal Mechanisms

A

DQ CRIME- Doxycycline: non-renally eliminated tetracycline, Quinolones: ciprofloxacin is renally eliminated butis a non-substrate inhibitor of P450 (caffeine and theophylline), Clindamycin: non-renally elim, Rifampin: inducer of P450 and hepatotoxicity, Isoniazid: hepatotoxicity, Metronidazole: DDI w/ alcohol due to inhibition of aldehyde metabolism (Anta-abuse reaction), Erythromycin-like: DDI due to inhibition of P450 (Ery-Clae, not Azi), Sulfonamides: renal crystalluria

50
Q

Cocci Gram + Bacterial Classification and Associated Diseases

A

S. pneumoniae (pneumonia, otitis media, sinusitis), S. pyogenes (pharyngitis), Viridans Streptococci (endocarditis), S. aureus (cutaneous infection, pneumonia, bacteremia, device associated infections), Enterococcus faecium-faecalis (bacteremia, intraabdominal infections, UTIs)

51
Q

Cocci Gram - Bacterial Classification and Associated Diseases

A

Neisseria gonorrheae

52
Q

Rods Gram - Bacterial Classification and Associated Diseases

A

E.coli (UTIs, intrabdominal infections, lower respiratory infections, bacteremia, traveler’s diarrhea), H. influenza, Klebsiella (UTIs, intraabdominal infections, lower respiratory infections, bacteremia), Pseudomonas aeruginosa (nosocomial infections at any site (UTIs and pneumonia)

53
Q

Anaerobe Gram + Rod Bacterial Classification and Associated Diseases

A

Clostridium difficile (pseudomembranous colitis), all other Clostridium

54
Q

Anaerobe Gram - Rod Bacterial Classification and Associated Diseases

A

Bacteroides fragilis (intraabdominal and brain abscess)

55
Q

Atypical Bacterial Classification and Associated Diseases

A

Chlamydia (trachoma, community-acquired pneumonia, urethitis), Mycoplasma pneumoniae (community-acquired pneumonia)

56
Q

Narrow Antibacterial

A

AGs, penicillinase-resistant penicillins, clindamycin, vancomycin, metronidazole, penicillin G/V.

57
Q

Extended Antimicrobial

A

Aminopenicillin (Amox-Amp), Cephalosporins, Fluoroquinolones (cip,levo), carbapenems.

58
Q

Broad Spectrum

A

Macrolides, FQ (Moxi, Gemi), Tetracycline,.

DD and BL (MHO) (4 decks)

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