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Block G -- Infection > Dr. Karatzios -- Antimicrobial Antibiotics > Flashcards

Dr. Karatzios -- Antimicrobial Antibiotics Flashcards

Contains only information highlighted in yellow from his slides

1
Q

4 potential pathogens that affect the nose and sinus

A
  • S. pneumoniae
  • GAS
  • S. aureus
  • H. influenzae
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2
Q

1 potential pathogen that may affect the throat/pharynx

A

GAS

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3
Q

5 potential pathogens that may affect the lungs/bronchi

A
  • S. pneumoniae
  • H. influenzae
  • S. aureus
  • Klebsiella spp.
  • Other enterbacteriaceae
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4
Q

1 potential pathogen that may affect the middle ear

A

S. pneumoniae

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5
Q

3 potential pathogens that may affect the stomach/duodenum and intestines

A
  • Salmonella
  • Shigella
  • E. coli O157:H7
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6
Q

2 potential pathogens that may affect the urinary tract

A
  • Enterobacteriaceae
  • Enterococcus
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7
Q

5 potential pathogens that may affect the CNS

A
  • N. meningitidis
  • H. influenzae
  • S. pneumoniae
  • Listeria
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8
Q

4 potential pathogens that may affect the eye

A
  • Haemophilus
  • Moraxella
  • N. gonorrhoeae
  • S. pneumoniae
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9
Q

2 potential pathogens that may affect wounds

A
  • S. aureus
  • GAS
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10
Q

3 potential pathogens that may affect bone and joint

A
  • S. aureus
  • GAS
  • Kingella kingae
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11
Q

6 antibiotics that have such good bioavailability that po=IV

A
  1. Clindamycin
  2. Fluoroquinolones
  3. Septra
  4. Tetracyclines
  5. Metronidazole
  6. Lindezolid
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12
Q

2 rate limiting steps that prevent someone from taking antibiotics orally even if bioavailability is so good that po = IV

A
  • GI tolerance
  • GI absorption (i.e. if patient is nauseated)
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13
Q

Define time-dependent activity

A

Depends on the AMOUNT of time that is spent above the minimum inhibitory concentration of the organism for that specific antibiotic at that specific place/tissue/organ

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14
Q

Define concentration-dependent activity

A

Depends on the CONCENTRATION above the minimum inhibitory concentration of the organism for that specific antibiotic at that specific place/tissue/organ

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15
Q

Mechanism of action of beta-lactams

A

Inhibition of cell wall synthesis by binding to penicillin binding proteins

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16
Q

3 modes of resistance that bacteria have developed against beta-lactams

A
  • Inactivation of antibiotic (penicillinase or beta-lactamase; i.e. most MSSA)
  • Mutated penicillin-binding protein (i.e. MRSA)
  • Decrease in penetration of antibiotics
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17
Q

Activity dependence of beta lactams

A

Time-dependent

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18
Q

5 families of beta-lactam antibiotics

A
  1. Penicillins
  2. Clavulanic acid
  3. Carbapenems
  4. Nocardicins, monobactams
  5. Cephalosporins, cephamycins, cephabacins
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19
Q

Organisms typically covered by penicillins

A
  • Gram-positive
  • Gram-positive anaerobes
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20
Q

Reason for S. aureus resistance to penicillin

A

Penicillinase

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21
Q

Reason for gram negative enterobacteriaceae resistance to penicillin

A

Beta-lactamases

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22
Q

Example of a new, resistant pathogen to penicillin

A

Pseudomonas spp.

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23
Q

2 penicillins designed to counter s. aureus and a potential drawback of these

A
  1. Cloxacillin
  2. Methicillin

Problem: gain in S. aureus activity = loss of anaerobic activity

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24
Q

2 penicillins designed to have expanded gram negative coverage (i.e. for e. coli)

A
  1. Ampicillin IV
  2. Amoxicillin (Amoxil) po

Both = aminopenicillins

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25
2 penicillins designed to counter pseudomonas aeruginosa
1. Ticarcillin 2. Piperacillin
26
Side effect of beta-lactamase inhibitors
Diarrhea
27
5 types of organisms covered by penicillins + beta-lactamase inhibitors
BROAD SPECTRUM: 1. S. aureus 2. Most gram + (i.e. enterococcus and listeria spp.) 3. Most gram neg. respiratory pathogens (i.e. haemophilus and moraxella spp) 4. Most gram neg. enteric bacteria 5. Most anaerobes (gram + and -)
28
6 types of organisms covered by timentin + pip/tazo
BROAD SPECTRUM: 1. S. aureus 2. Most gram + (i.e. enterococcus and listeria spp.) 3. Most gram neg. respiratory pathogens (i.e. haemophilus and moraxella spp) 4. Most gram neg. enteric bacteria 5. Most anaerobes (gram + and -) 6. **\*\*AND pseudomonas spp.**
29
General trend of activity of cephalosporins
30
Gram negative exceptions to the general trend of cephalosporin activity
*Pseudomonas *spp. * No activity with 1st and 2nd generation * 3rd generation = ONLY ceftazidime * 4th generation = yes *Campylobacter *spp. = no activity with ANY generation
31
Gram positive exceptions to the general trend of cephalosporin activity
***Enterococcus *spp**. and ***Listeria *spp**. = no activity whatsoever with ANY generation
32
Organisms covered by carbapenems
BROAD SPECTRUM (similar to beta-lactams/beta-lactamase inhibitor combinations) * Gram + (MSSA) * Gram - * Anaerobes NOTE: Usually resistant to beta-lactamases
33
Recent emergence of what type of organism that is resistant to carbapenems?
Gram-netaive enteric rods
34
3 mild side effects of all beta-lactams
* GI upset * Diarrhea (beta-lactamase inhibitors; cefixime/Suprax) * Drug-induced neutropenia
35
2 serious side effects of beta lactams
* Seizures (up to 14g threshold) * Anaphylaxis (10% cross-reactivity between penicillins and carbapenems)
36
Beta lactam that lowers the seizure threshold more than others
Imipenem
37
5 beta-lactams that cross the BBB appreciably
1. Penicillin IV (high dose) 2. Ampicillin IV (high dose) 3. 3rd gen. cephalosporins IV (high dose) 4. Cefepime 5. Carbapenems
38
6 Beta-lactams that have activity against MSSA
1. Cloxacillin po/IV (and methicillin) 2. Beta-lactam/beta-lactamase combinations (po/IV) 3. 1st generation cephalosporins po/IV 4. 2nd generation cephalosporins po/IV 5. Cefepime 6. Carbapenems NOTE: 3rd generation IV NOT that good -- just OK
39
5 beta-lactams with activity against *Pseudomonas *spp.
1. Ticarcillin and Piperacillin (IV) 2. Timentin and Pip/tazo (IV) 3. Ceftazidime (IV) 4. Cefepime (IV) 5. Carbapenems (IV)
40
3 beta-lactams that have activity against anaerobes
1. Penicillin (po/IV) 2. All beta-lactam/beta-lactamase combinations (po/IV) 3. Carbapenems (IV)
41
Mechanism of action of vancomycin
Inhibition of the cross-linking of peptidoglycan
42
Antibacterial spectrum of vancomycin
* Only gram-positive * Includes anaerobic gram-positive * Very good against *C. difficile* (oral)
43
Penetration of vancomycin (3 points)
* BBB penetration, mainly with inflammation * Need higher levels to penetrate BBB, bone and cartilage, heart tissue * Need higher levels when dealing with MRSA
44
2 adverse reactions of vancomycin
1. Nephrotoxicity 2. Histamine release (red-man syndrome) when administered over short period (\< or = 1 hour)
45
2 reasons why nephrotoxicity would occur with vancomycin
* Usually with accumulation (high trough levels) * When co-administered with other nephrotoxic drugs
46
3 manifestations of red-man syndrome
1. Flushing 2. Hives 3. Even hypotension
47
2 types of gylcopeptide antibiotics
Vancomycin Teicoplanin
48
3 macrolide antibiotics
* Erythromycin (IV/po) * i.e. Erythromycin estolate (po) * Clarithromycin (po) * i.e. Biaxin * Azithromycin (IV/po) * i.e. Zithromax
49
Ketolide antibiotic
Telithromycin (po) Example = Ketek
50
Antibacterial spectrum of macrolides and ketolides (4 types)
* Gram-positives * Gram-negatives * Atypical bacteria * Non-tuberculous mycobacteria
51
2 gram-positive bacteria that are affected by macrolides/ketolides **if S**
* *S. pneumoniae* * GAS
52
2 examples of gram-negatives affected by macrolides/ketolides
* *Campylobacter *spp. * *Bordetella pertussis*
53
3 examples of atypical bacteria affected by macrolides/ketolides
* *Mycoplasma *spp. * *Chlamydia *spp. * *Clamydophila *spp.
54
2 macrolides that affect non-tuberculous mycobacteria
* Clarithromycin * Azithromycin
55
5 aminoglycosides
1. Gentamicin 2. Tobramycin 3. Amikacin 4. Streptomycin 5. Paromomycin
56
General antibacterial spectrum of aminoglycosides
Gram-negative (including *P**seudomonas *spp.)
57
Exceptions to the gram-negative rule of aminoglycoside coverage (2)
* *Salmonella *spp. * *Neisseria *spp.
58
2 bacteria that only some aminoglycosides have activity against
TB and non-TB mycobacteria
59
Aminoglycoside that has anti-parasitic activity and the parasite against which it acts
Paromomycin for *giardia lamblia*
60
3 adverse reactions of aminoglycosides
* Renal toxicity * Vestibular and cochlear toxicity * Muscular blockade
61
2 reasons that renal toxicity may occur with aminoglycosides and whether it is reversible
1. High trough levels 2. Increased if co-administered with other nephrotoxic drugs Reversible = YES
62
Reason for vetsibular and cochlear toxicity with aminoglycosides and whether it is reversible
Usually due to prolonged use IRREVERSIBLE hearing loss
63
First problem sign of vestibular and cochlear toxicity with the use of aminoglycosides
Tinnitus
64
For which patients should aminoglycosides be avoided
People with neuromuscular diseases (due to muscular blockade)
65
3 fluoroquinolones
* Ciprofloxacin po/IV (Cipro) * Levofloxacin po/IV (Levaquin) * Moxifloxacin po (Avelox)
66
The respiratory quinolone
Levofloxacin po/IV (Levaquin)
67
Antibacterial spectrum of fluroquinolone --\> trends against: * *S. pneumoniae* * *MSSA* * Enteric gram negative rods * *Pseudomonas* spp. * Atypicals
68
2 bacteria for which fluoroquinolone coverage is only achieved by 4th generation
* *Enterococcus faecalis* * Anaerobes
69
Oral vs. IV availability of fluoroquinolones
IV = oral
70
3 sulfonamides
1. Trimethoprim-sulfamethoxazole (Septra) 2. Sulfadiazine 3. Dapsone
71
Antibacterial spectum of Septra (3 main points)
BROAD SPECTRUM -- all bacteria requiring endogenous folic acid synthesis * Gram + and gram - * Includes: * *Enterobacteriaceae* * *Shigella* * *S. maltophilia* * *B. cepacia* * *Chlamydia* * *Nocardia* *​*Anti-parasitic activity: *Toxoplasma* Anti-fiungal activity: *Pneumocystis jeroveci*
72
2 organisms against which septra has no activity
* GAS * *Enterococcus *spp.
73
Oral vs. IV availability of sulfonamides
Oral = IV
74
3 types of organisms covered by tetracyclines
1. Gram-negative enteric rods 2. Anaerobes 3. Atypical bacteria
75
4 types of organisms covered by tigecycline
1. Gram-negative enteric rods * Even those resistant to tetracyclines * Multiresistant enterbacteriaceae 2. Gram-positive 3. Anaerobes 4. Atypical bacteria
76
3 types of gram-positive bacteria that are susceptible to tigecycline even though they are resistant to other antibacterials
* MRSA * VRE * Penicillin-resistant S. pneumoniae
77
Oral vs. IV availability of the "cyclines"
Oral = IV
78
Mechanism of actio nof clindamycin
Inhibition of protein synthesis
79
Resistance of clindamycin (2)
* Modification of target site * Efflux pump NOTE: similar to macrolides (most gram-negatives have intrinsic resistance to macrolides)
80
Activity dependence of clindamycin
Bacteriostatic time-dependent activity
81
Antibacterial spectrum of clindamycin (4 points)
* Good gram-postiive coverage (incl. *S. pneumoniae *and *S. aureus*) * ONLY if erythromycin S * Good anaerobic activity * **NO** gram-negative coverage * **NO ***Entercoccus *spp. activity
82
Oral availability equivalence of clindamycin
Oral = IV/IM availability
83
2 adverse effects of clindamycin
* May cause moderate diarrhea * Associated with *C. difficile *colitis
84
Coverage of metronidazole (2)
* Anaerobes (gram + and gram -) * *C. difficile* * Antiparasitic activity
85
2 parasites against which metronidazole works
* *Giardia lamblia* * *Entamoaba histolytica*
86
Oral availability equivalence of metronidazole
Oral = IV
87
Why shouldn't you use rifamycins alone
On their own, induce RAPID resistance * Always use with other antibiotics as buffer * Can be used alone as prophylaxis
88
Situation wherein rifamycin can be used alone as prophylaxis
Post-exposure prophylaxis against development of meningitis from *N. meningitides *and *H. influenzae*
89
2 treatment uses for rifamycins
1. TB 2. Non-TB mycobacteria
90
Major drug interactions of rifamycins
Both are metabolized in the liver and induce CYP-450 enzymes
91
2 rifamycins
* Rifampin * Rifabutin
92
3 general adverse reactions of rifamycins
* Nausea * Increase in liver enzymes * Skin rashes
93
Specific adverse reaction of rifampin
Oreange-red coloration of body fluids (urine,tears) --\> May permanent contact lenses
94
2 specific adverse reactions of rifabutin
* Bronze discoloration of skin * Violet-red coloration of urine
95
Only use for nitrofurantoin and why
UTI treatment and prophylaxis (Therapeutic concentrations achieved ONLY in urine)
96
3 antibiotics specifically produced for multiresistant gram-positive bacteria (MRSA AND/OR VRE)
1. Oxazolidinones * Linezolid 2. Streptogramins * Quinipristin/Dalfopristin 3. Daptomycin
97
Oral availability equivalence of linezolid
Oral = IV
98
2 averse reactions of linezolid
* Reversible thrombocytopenia * Serotonin syndrome (inhibitor of monamine oxydase)
99
When is there an increased risk of thrombocytopenia when using linezolid
Prolonged treatment \>2 weeks
100
2 things to avoid when administering linezolid to a patient
* Avoid SSRI * Avoid or limite tyramine-containing foods (i.e. cheeses, smoked and processed meats)

Block G -- Infection (23 decks)

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