DPT Antibiotics: I

Question 1

carbapenems (as a class): coverage, side effects, advantages, MOR

Answer 1

carbapenems cover more gram negatives and are relatively resistant to beta lactamases.
resistance through changes in gram negative porin channels
Excellent CNS penetration
Lots of cross allergies with penicillins and tend to have higher than average seizure risks.

Question 2

Imipenem/meropenem: class, coverage, uses

Answer 2

carbapenems. cover gram positives, gram negatives including pseudomonas, anaerobes. Don’t cover entercoccoi. show CNS penetration and relatively little resistance. used in pts with pancreatitis to reduce complications.

Question 3

Imipenem side effects

Answer 3

especially high sezure risk, esp. in ppl with renal insufficiency. also very bad for kidneys

Question 4

Ertapenem: class, coverage, uses

Answer 4

carbapenem. covers gram postives, negatives, and anaerobes, but does NOT cover pseudomonas or enterococci (note the loss of pseudomonas coverage). however, it is useful because it is PO and has once daily dosing. It also doesn’t lower the seizure threshold as much as other carbapenems. used for intra-abdominal abscesses.

Question 5

Azotreonam: class, coverage, etc

Answer 5

this is a monobactam. It covers gram negative rods, including pseudomonas, but NOT gram positives or anaerobes. It is mostly used for penicillin allergic folks. Lots of cross-resistance with penicillin resistant bugs. kind of wimpy.

Question 6

Vancomycin: MOA and MOR

Answer 6

binds lipid-sugar peptide complex at the D-Ala-D-Ala moiety. this prevents elongation of sugar backbone, and prevents crosslinking among those strands that do form. MOR by mutations from D-Ala-D-Ala to D-Ala-D-Lac

Question 7

Vancomycin coverage

Answer 7

gram positive bacteria, including MRSA, enetrococci, strep, and clostridia. doesn’t cover any gram negatives.

Question 8

Vancomycin side effects

Answer 8

NEPHROTOXIC, esp. when combined with other nephrotoxins. measure drug troughs. Red man syndrome if infused too rapidly (histamine mediated). Not an allergy- ok to give again, just go slower.

Question 9

Use and administration of vancomycin

Answer 9

IV (usually), PO to treat C diff (not good absorption from the gut). moderate CNS access.

Question 10

Clarithromycin. Class, cidal/static, and coverage.

Answer 10

This is a macrolide (static) that binds 50S subunit.
GAS when you can’t us penicillin, and MAC in HIV.
Also for community acquired pneumonia, pseudomonas, pertussis, mycoplasma, chlamydia.
Does NOT cover staph, pseudomonas, enterococcus.
Complete list:
covers many mouth, throat, and resp bacteria: S pneumo, haemophilus, viridans (which the strep of cavities and endocardidis) , GAS, legionella, pertussis, morexella, chlamydia, mycobacteria, h pylori, borrelia, bartonella, toxoplasma, treponemes.

Question 11

Clarithromycin: side effects

Answer 11

can prolong the QT interval. (static macrolide binds 50S)

Question 12

Azithromycin: class, static/cidal, coverage, uses

Answer 12

macrolide, static, 50S. good for community acquired pneumonia, pertussis, mycoplasma, chlamydia, h. pylori. GAS when penicillin can’t be used. MAC prophylaxis in HIV. Prevention of CF and COPD infections?
technically covers a lot of stuff: plasmodium falciparum, plus s pneumo, haemophilus, viridans, GAS, legionella, pertussis, morexella, chlamydia, mycobacteria, h pylori, treponemes, borrelia, bartonella, toxoplasma

Question 13

clindamycin: MOA, class, static/cidal

Answer 13

lincosamide. binds 50S. static.

Question 14

clindamycin: coverage and uses.

Answer 14

anaerobes above the diaphragm, some MRSA, MSSA, GAS. good for anaerobic lung abscesses, and treats toxin producing infections to stop toxin formation. toxoplasmosis in ppl with sulfa allergies.
doesn’t cover gram negatives at all.

Question 15

clindamycin sides. Administration

Answer 15

C diff! Rash, but you can treat through it. PO and IV administration.

Question 16

Aminoglycosides: MOA and examples. Administration, static/cidal

Answer 16

cidal and bind 30S. include gentimicin, streptomycin, amikacin, tobramycin. IV only. cidal

Question 17

uses of aminoglycosides. limitations

Answer 17

Use amikacin for infection prophylaxis in CF.

Also for empiric combo in life-threatening infection, syndergistic therapy for S aureus and enterococcual endocardidis, tularemia and plague, and TB for strep and amikacin and atypical mycobacteria for amikacin.

aerobic gram negatives (incl. pseudomonas), staph, strep, and enterococci when combined with cell-wall active drug, francisella tularensis, yersinia, brucella (strepto and genta_ and mycobacteria (amikacin, strepto). Do NOT cross BBB and don’t do well with abscesses.

Question 18

aminoglycosides: side effects

Answer 18

nephrotoxicity and ototoxicity, including vestibular problems.

Question 19

tetracyclins: name them, adminstration, MOA, static/cidal.

Answer 19

tetracyclin, minocyclin, doxycyclin, tigecyclin. bind 30S (TAT: thirty are aminoglycocides and tetracyclins). tetra, mino, and doxy are PO, tigecylcin is IV

Question 20

coverage/uses of tetracyclin, minocyclin, doxycyclin

Answer 20

broad coverage, but usually must be combined with other drugs. Use for rickettsial diseases, brucellosis, Lyme, chlamydia, PID in combo with other drugs. (important)

Activity against vibrio, ataypicals like chlamydia, rickettsia, atypical mycobacterium, borrelia burdoferi, brucella (with gentamicin).

Question 21

Side effects of tetracyclin, minocyclin, doxycyclin

Answer 21

photosensitivity. GI. Interferes with bone and enamel formation in kids and fetuses. minocyclin can cause vertigo.

Question 22

Tigecyclin: coverage and side effects

Answer 22

MRSA, VISA, VRE, penicillin resistatn pneumococcus, most gram negatives. NOT pseudomonas, (proteus, providential). binds protein too much to be used in bacteremias. give IV. but is falling out of favor bc these pts die more of infections than with other drugs.