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Infectious Disease > Drugs: Basics > Flashcards

Drugs: Basics Flashcards

1
Q

What is the best drug to use for hospital-acquired MRSA?

A

-Vancomycin

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2
Q

What is MRSA resistant to?

A
  • Penicillin

- Cephalosporin

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3
Q

What is natural penicillin (Penicillin VK and aqueous Penicillin G) good at treating?

A
  • Gram positive (streptococci)

- Anaerobes (oral only)

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4
Q

What is natural penicillin the drug of choice for?

A
  • N. meningitidis

- Syphilis

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5
Q

What are aminopenicillins good at treating?

A
  • Gram positive (streptococci, enterococci)
  • Some gram negatives
  • Anaerobes (oral only)
  • Often resistance w respiratory infections
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6
Q

What are the penicillinase-resistant penicillins?

A
  • Dicloxacillin

- Nafcillin

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7
Q

What are the penicillinase-resistant penicillins good at treating?

A
  • Drug of choice for MSSA!
  • Gram positive: streptococcus, MSSA
  • Anaerobes (oral only)
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8
Q

What are the aminopenicillins?

A
  • Ampicillin

- Amoxicillin

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9
Q

What are the extended-spectrum penicillins?

A
  • Piperacillin

- Ticarcillin

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10
Q

What are the extended-spectrum penicllins good at treating?

A
  • Broad spectrum, severe infections
  • Gram positive: streptococcus, staphylococcus
  • Gram negative: excellent! include coverage against pseudomonas
  • Anaerobes (oral); but there are better ones out there
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11
Q

Are the extended spectrum penicillins available orally or IV?

A

-IV only. You reserve these for pretty severe issues, like pseudomonas and bad gram-negative pathogens.

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12
Q

What does adding a beta-lactamase inhibitor to your penicillins do?

A

-It takes away the major resistance mechanism. Now, you have a drug that is 1) great against MSSA, 2) increases coverage against all enterobacteriacea, 3) great against anaerobes.

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13
Q

What penicillins are best for treating MSSA?

A

Dicloxacillin and nafcillin (the penicillase-resistant penicillins)

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14
Q

What penicillins are best for treating MRSA?

A

None!

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15
Q

What penicillins are best for treating psuedomonas?

A

Piperacillin and tazocillin (the extended-spectrum penicillins)

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16
Q

What penicillins are best for treating anaerobes?

A
  • Penicillin for oral anaerobes

- Am/sulbactam and pip/tazo for B.fragilis

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17
Q

What are common adverse reactions to penicillins?

A
  • Allergic reactions

- Diarrhea

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18
Q

What are the first generation cephalosporins?

A
  • Cefazolin

- Cephalexin

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19
Q

What are the second generation cephalosporins?

A
  • Cefuroxime

- Cefoxitin

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20
Q

What are the third generation cephalosporins?

A
  • Ceftriaxone

- Ceftazidime

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21
Q

What is the fourth generation cephalosporin?

A

-Cefepime

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22
Q

Which of the cephalosporins is only available orally?

A

-Cephalexin

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23
Q

Which of the cephalosporins is available both IV and orally?

A

-Cefuroxime

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24
Q

What are first generation cephalosporins good at covering?

A
  • Great gram + coverage: streptococcus, MSSA
  • Not good gram - coverage; some e.coli, klebsiella
  • Anaerobes: oral only

Bottom line: good for skin infections, some respiratory. Main activity is against strep and staph

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25
Q

What are the second generation cephalosporins good at covering?

A
  • Moderate gram + and gram - coverage
  • Some respiratory (oral)
  • Anaerobes: can cover b.fragilis!!

Bottom line: they are moderately good for covering a lot of things, which is why they are not used a lot - don’t have a niche.

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26
Q

What are the third generation cephalosporins good at covering?

A
  • Great gram - coverage (includes pseudomonas wtih ceftazidime coverage)
  • Not good gram + coverage

Bottom line: good for respiratory infections, serious infections

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27
Q

What is the fourth generation cephalosporin good at covering?

A

-Both gram - (inc. pseudomonas) and gram + (strept, MSSA)!
-Anaerobes (oral only)
But is $$$

Bottom line: used for serious hospital infections. Not so good for MRSA (use vanco instead).

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28
Q

What do none of the cephalosporins cover?

A

Enterococcus

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29
Q

What kind of infections might present with enterococcus?

A

Intraabdominal infections

Diabetic foot ulcers with mixed flora

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30
Q

What is the new cephalosporin on the market and what is it good for?

A
  • Ceftaroline!
  • Covers MRSA (the only ceph to do so!)
  • Covers strep pneumo
  • Covers gram negative rods (doesn’t cover pseudomonas)
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31
Q

When do we really use ceftaroline?

A

For MRSA. We don’t use it widely, we are reserving this puppy for something really resistant.

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32
Q

What is the only cephalosporin that covers b.fragilis?

A

-Cefoxitin (a 2nd gen ceph)

33
Q

What are the only cephalosporins that cover pseudomonas?

A

-Ceftazidime (a 3rd gen) and cefepime (4th gen)

34
Q

What do ALL of the cephalosporins cover?

A

-MSSA, e.coli, klebsiella, h.flu, oral anaerobes

35
Q

What are adverse reactions of the cephalosporins?

A
  • Allergic reactions (3-7% cross resistance with PCN allergy)
  • Diarrhea
36
Q

What are the carbapenems?

A
  • Imipenem
  • Meropenem
  • Ertapenem
  • Doripenem
37
Q

What can the carbapenems cover?

A
  • Very broad spectrum! Only really used in severe infections
  • Excellent anaerobic coverage
  • Key forte: gram negatives; most can cover pseudomonas!
  • No MRSA coverage, not terrible MSSA drugs.

Bottom line: use these for when you want to “throw the kitchen sink” at someone in a severe case where you need good broad spectrum coverage.

38
Q

What is the one carbapenem that doesn’t cover pseudomonas?

A

-Ertapenem

39
Q

What are the adverse reactions of carbapenems?

A

-Gastrointestinal

40
Q

Are the carbapenems available orally or IV?

A

IV only

41
Q

What kind of patients should you NOT use carbapenems with?

A

Those with severe PCN allergies

42
Q

What are the aminoglycosides?

A
  • Gentamicin
  • Tobramycin
  • Amikacin
43
Q

What is the coverage like for aminoglycosides?

A
  • Good gram negative, includes pseudomonas coverage
  • Only synergistic gram + activity, so would not use this to cover gram +’s by themselves
  • Do not cover ANY anaerobes!!
44
Q

What are the adverse reactions of aminoglycosides?

A
  • Nephrotoxicity 10-15%! (usually reversible)
  • Ototoxicity 1-5% (often irreversible)

Yikes. So dose very carefully due to toxicity potential. Dosage according to weight, renal function, and severity/site of infection.

45
Q

What are the fluoroquinolones?

A
  • Ciprofloxacin
  • Levofloxacin
  • Moxifloxacin
  • Gemifloxacin
46
Q

What are the fluoroquinolones good at covering?

A
  • Potent agents
  • Most gram - (including psuedomonas)
  • Some gram + (strept, MSSA)
  • Anaerobes: minimal

Bottom line: good at covering atypical respiratory pathogens! Legionella, chlamydia pneumoniae, mycoplasma pneumoniae

47
Q

Which fluoroquinolone is NOT good at covering MSSA or a respiratory infection caused by strep?

A

Ciprofloxacin - don’t use it!

48
Q

What are the adverse effects of the fluoroquinolones?

A
  • Nausea

- HA, dizziness, insomnia

49
Q

Which of the classes of drugs have faced major resistance issues recently (starting in 1994)?

A

Fluoroquinlones!! Use with caution!

50
Q

What are the macrolides?

A
  • Erythromycin
  • Clarithromycin
  • Azithromycin
51
Q

What are the macrolides good at covering?

A
  • Respiratory infections
  • Gram positive: strept
  • Anaerobes (oral only)
  • Atypical respiratory pathogens! Legionella, chlamydia pneumoniae, mycoplasma pneumoniae
52
Q

What is the only gram negative that we cover with the macrolides?

A

H. influenzae

53
Q

What are the adverse reactions of the macrolides?

A
  • GI

- Phlebitis w IV erythro

54
Q

Which macrolide is more commonly associated with the adverse reactions?

A

-Erythromycin

55
Q

Which macrolide usually has less severe adverse reactions?

A

Azithromycin

56
Q

What are the anti-anaerobe drugs?

A
  • Metronidazole

- Clindamycin

57
Q

For which anti-anaerobe drug does resistance more commonly occur?

A

-Clindamycin

58
Q

What does metronidazole cover?

A

ONLY anaerobes!!! Great b.fragilis coverage, pretty good oral anaerobe coverage
-No gram + or gram - coverage

59
Q

What does clindamycin cover?

A
  • Gram positives: strept, MSSA
  • Gram negative: none!
  • Anaerobes: great oral anaerobe coverage, ok w b.fragilis
60
Q

What is the hallmark agent responsible for c.diff?

A

-Clindamycin

61
Q

What are some common adverse reactions of clindamycin?

A
  • Diarrhea

- C.diff

62
Q

What are some adverse reactions to metronidazole?

A
  • Nausea
  • Metallic taste
  • Drug interaction with alcohol - flushing, sweating, nausea
63
Q

Are the anti-anaerobes available orally or IV?

A

Both are available in both formulations

64
Q

What is the coverage of vancomycin?

A
  • Gram +: covers strept, all staph, moderate enterococcus coverage
  • NO gram - coverage
  • Anaerobes: gram + oral only

BOTTOM LINE: drug of choice for hospital-acquired MRSA

65
Q

What is the coverage of linezolid?

A
  • Gram +: strept, all staph, enterococcus
  • Gram -: none (eh, h.flu)
  • Anaerobes: none

BOTTOM LINE: gram positives only, used for serious infections, resistance is rare for this. Drug of choice for VRE (vancomycin resistant enterococcus)!

66
Q

What is the coverage of daptomycin?

A
  • Gram +: strept, all staph, all entero
  • Gram -: none
  • Anaerobes: none

BOTTOM LINE: gram +s only, for serious infections
A second line agent used for resistant pathogens when vanco has failed.

67
Q

What are the adverse reactions of vancomycin?

A
  • “red man” syndrome: infusion related flushing
  • Nephrotoxicity with other agents and ototoxicity with high concentrations (but not as big a problem as with fluoroquinolones)
68
Q

What are the adverse reactions of linezolid?

A
  • Thrombocytopenia
  • Anemia
  • Neutropenia
69
Q

What are some precautions that you should take when administering vancomycin?

A
  • Weight and renal function based dosing (so do carefully!)

- Monitor renal function when using other nephrotoxins

70
Q

What is the coverage of trimethoprim-sulfamethoxazole (bactrim)?

A
  • Variable wide activity
  • Gram +: strept, MSSA
  • Gram -: most enterobacteriaceae
  • Anaerobes: oral only

BOTTOM LINE: small pockets of use: UTIs, some skin infections, etc

71
Q

What is the coverage of tetracyclines?

A
  • Gram +: strept, MSSA
  • Gram -: h.flu
  • Anaerobes: mostly oral
  • Atypical respiratory pathogens: legionella, c.pneumoniae, m.pneumoniae

BOTTOM LINE: used for respiratory and intracellular infections, includes coverage for atypical respiratory pathogens

72
Q

What are the adverse reactions of TMP/SMX?

A
  • Allergic reactions
  • GI effects
  • Neutropenia, thrombocytopenia
73
Q

What are the adverse reactions of tetracyclines?

A
  • Photosensitivity
  • Nausea and diarrhea
  • Tooth discoloration in kiddos
74
Q

What do you need to be careful for with TMP/SMX?

A

Increases the effects of warfarin

75
Q

What do you need to be careful about with tetracyclines?

A

-Don’t take with dairy products/calcium/cations because they will chelate w these products

76
Q

What drugs cover pseudomonas?

A
  • Aminoglycosides (gentamicin, tobramycin, amikacin)
  • Cipro, levo (the only oral drugs) (fluoroquinolones)
  • Ceftazidime, cefepime (2nd and 4th gen cephs respectively)
  • Piperacillin, ticarcillin (the extended-spectrum penicillins)
  • Impenem, meropenem, doripenem (most of the carbapenems)
77
Q

What drugs cover hospital-acquired MRSA?

A
  • Vancomycin
  • Linezolid
  • Daptomycin
78
Q

What are the best drugs for covering anaerobes?

A
  • Metronidazole
  • Imipenem, meropenem, ertapenem
  • Beta lactam/beta lactamase inhibitors

Infectious Disease (8 decks)

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