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Drugs Flashcards

1
Q

beta lactams work against (growing/dormant) bacteria

A

growing

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2
Q

properties of beta lactams

A

work on growing bacteria, bacteriacidal, killing is indirect, leads to dysregulation of autolysins and lysis, bind to PBP, inhibit transpeptidases

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3
Q

mechanism of resistance of beta lactams

A
  1. inactivation by beta-lactamase
  2. alteration of drug target (PBP)
  3. decreased penetration to target site
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4
Q

beta lactams exhibit what time of killing

A

time dependent

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5
Q

adverse reactions of beta lactams

A

immediate IgE reactions, late allergic reactions (serum sickness) - late are most common

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6
Q

basic facts of penicillin

A

narrow spectrum, low cost, good index, good tissue penetration

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7
Q

bugs for penicillin

A

gram positive cocci: Group A/B strep, enterococcus
gram negative rods: pasturella multocida
gram negative diplococci: neisseria meningitidis
spirochetes: treponema pallidum, borrelia burgdorferi
oral anerobes: peptostreptococci

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8
Q

clinical use of penicillin

A
  1. pharyngitis (group A strep)
  2. dental abscess
  3. syphilis
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9
Q

basics of oxacilin

A

use for penicillinase producing S aureus, very narrow spectrum

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10
Q

use of oxacilin

A

methicillin sensitive staph aureus

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11
Q

adverse effects of oxacillin

A

interstitial nephritis**, elevated LFTs, neutropenia, allergies

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12
Q

basics of ampicillin

A

intermediate spectrum - same as penicillin plus enterococcus, some gram negative bacilli

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13
Q

resistance in ampicillin

A

all Haemophilus spp isolates should undergo sensitivity testing, some enterococcal can be resistant

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14
Q

amoxicillin uses

A

oral only, for bronchitis, pharyngitis, otitis media, dental prophylaxis in heart disease

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15
Q

ampicillin uses

A

oral and IV, meningitis due to listeria monocytogenes, bacteremia from enterococcus

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16
Q

bugs of piperacillin

A

broad spectrum - gram negatives, enterobacter and pseudomonas aeruginosa, gram positives like strep

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17
Q

clinical uses of piperacillin

A

pelvic infections, hospital acquired pneumonia, bacteremia, UTI, gram neg skin infections

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18
Q

sulbacam

A

beta lactamase inhibitor

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19
Q

clavulanate

A

beta lactamase inhibitor

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20
Q

beta lactamase inhibitors active against

A

oral and gut anerobes (peptostreptococci and bacteroides)

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21
Q

uses of intermediate spectrum/beta lactam inhibitors

A

intra-abdominal and pelvic infections (mixed), skin and tissue infections, diabetic foot infections

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22
Q

penicillin with activity against psuedomonas

A

piperacillin, usually given with BLase tazobactam

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23
Q

adverse effects of broad spectrum penicillins

A

large effect of gut flora, C diff infections

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24
Q

characteristics of cephaloporins

A

bactericidal, well tolerated, time dependent killing, less allergic reaction, not active against enertococci

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25
properties of cefazolin
first generation cephalo, active against gram positive cocci, used in penicillinase producing s aureus not methicillin resistant' - used in patients allergic to oxacillin
26
uses of cefazolin
1 - surgical prophylaxis (suppress growth of skin flora), bacteremias and skin and tissue infections
27
properties of cefuroxime
second generation cephalo, active against gram positive cocci, H influenzae with beta lactamase**, E coli and klebsiella
28
uses of cefuroxime
2 - otitis media, bronchitis, pneumonia, sinusitis, UTI | - especially with isolate with beta lactamase
29
properties of cefoxitin
second generation - activity against oral and bowel anaerobes (bacteroides fragilis) and neisseria gonorrheae
30
properties of ceftriaxone
3 - penetration to CNS**, less staph more strep, gram negative rods, no activity for pseudomonas think meningitis and pneumonia
31
uses of ceftriaxone
3- pneumonia, bacteremia, meningitis, UTI
32
uses of cefoxitin
2 - intra abdominal infections, pelvic infections, diabetic foot infections
33
properties of ceftazidime
3 - poor gram positive, no anaerobe, used for pseudomonas**, CNS penetration
34
properties of cefepime
4- broad spectrum, gram positive and negative, pseudomonas
35
uses of cefepime
4 - hospital acquired infections, neutropenic patients with fever and unknown organism
36
properties of ceftaroline
5 - gram positive and MRSA, affinity for PBP2a, gram negatives but not pseudomonas used fro penumonia and soft tissue infection
37
adverse effects of cephalosporins
kidney excretion, C diff
38
properties of aztreonam
monobactam - narrow spectrum for gram neg only including pseudomonas low allergy potential, well tolerated
39
uses of aztreonam
gram negative rod infection - UTI, bacteremia, sub for aminoglycoside in renal patient
40
imipenem/cilastatin properties
carbapenems - imipenem is active, cilastatin inhibits degredation - very broad action, penetrates gram negatives everything but MRSA, coag neg staph, others
41
three factors of imipenem
1. no permeability barrier in gram neg 2. stability against beta lactamases 3. high affinity for PBP
42
adverse reactions in imipenem
seizure, dose modification in renal patients, N/V, allergy
43
vancomycin properties
glycopeptide (inhibits peptidoglycan synthesis)- active against gram positive resistant bacteria
44
uses of vancomycin
MRSA, resistant meningitis, gram positive infections, orally for C diff colitis
45
adverse effects of vancomysin
- red man syndrome - rash, not immune - kidney toxic - ototoxic - rare - monitor drug levels
46
propertis of daptomycin
lipopeptide - binds to bacterial cell membrane, forms channel and destroys gradient
47
use of daptomycin
gram positive s aureus, enterococci, strep, coag neg staph used in bacteremia, endocarditis, NOT pneumonia
48
properties of fluroquinolones
inhibit DNA gyrase and topoisomerase, bactericidal*
49
general uses of fluroquinolones
gram neg bacilli, atypical pneumonia, gram pos cocci, meningococcus, pseudomonas, TB
50
uses of ciproflaxacin
mainly for gram negatives, pseudomonas
51
uses for levofloxacin
some gram negative, better gram positive (s pneumoniae and s aureus)
52
uses for moxifloxacin
gram neg, no pseudomonas, better gram positive and some anaerobic
53
trends of ciprofloxacin, levofloxacin, moxifloxacin
less pseudomonas and more gram pos/anaerobic
54
pharm of fluroquinolones
cations will bind and interfere, should not be given with Fe, Ca, Zn -
55
resistance of fluroquinolones
active efflux pumps, mutations in gyrase enzyme
56
adverse effects of fluroquinolones
QT prolong, tendon rupture, arthritis, seizures, NV, interactions
57
MOA of sulfonamides
inhibits folic acid synthesis has a bacteriostatic effect
58
resistance of sulfamethoxazole
decreased permeability, decreased enzyme affinity, efflux, PABA production
59
spectrum of sulfamethoxazole
community strains of MRSA, gram negative rods (not pseudomonas), malaria, toxoplasma, pneumocysitis
60
uses of sulfamethoxazole/trimethoprim
UTI, skin/tissue, MRSA, respiratory tract, treatment of pneumocystis jirovecii pneumonia
61
adverse effects of sulfamethoxazole
hypersensitivity, kernicterus, rashes, nephrotoxic, GI
62
properties of metronidazole
direct damage to DNA by reduction of nitro group - rapidly bactericidal
63
spectrum of metronidazole
gram neg anaerobes, gram pos anaerobes, protozoa, used in mix infections with GNR and anaerobes
64
uses of metronidazole
mild C diff, mixed abdominal infections with PCN allergy, protozoa
65
adverse effects of metronidazole
GI, neurologic (peripheral neuropathy), drug interactions
66
nitrofurantoin
urinary only, reactive intermediates, low resistance
67
properties of protein synthesis antibiotics
bacteriostatic, slow growing organisms, have target site modification and active efflux
68
uses for protein synthesis
problems with beta lactams, intracellular pathogens, no cell walls, synergy, slow growing bacteria
69
properties of linezolid
binds to 50S, resistant GPC (MRSA and VRE) with rare resistance
70
adverse effects of linezolid
bone marrow suppression and serotonin syndrome
71
properties of tetracyclines
bind 30S, block t-RNA, intracellular penetration, active against cells calls - broadest spectrum of protein inhibitors bacteriostaic
72
spectrum of doxycycline
think as tick borne agent - borrelia, richettsiae, chlamydiase, ehrlichia, mycoplasma and others
73
resistance of tetracyclines
widespread, efflux, side modification
74
adverse effects of tetracyclines
teeth and bones, enamel hypoplasia, GI, skin - photosensitivity, CNS
75
uses of tigecycline
hospital infectsion, intraabdominal infections
76
properties of aminoglycosides
30S binding, bacteridial, toxic, gram negative bacili, use instead of quinolones or latams
77
MOA of aminoglycosides
uses active transport, not taken up in anaerobes, block protein synthesis, has post antibiotic effect

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