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Clinical Pharmacology > Drugs for bacterial infections 1 > Flashcards

Drugs for bacterial infections 1 Flashcards

1
Q

What type of pathogens are:
* strep
* staph
* entero
* listeria?

A

gram positive

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2
Q

What type of pathogens are
* clostridia
* bacteroides?

A

anaerobes

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3
Q

What type of pathogens are:
* chlamydiae
* mycoplasma
* legionella?

A

atypicals

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4
Q

What type of pathogens are:
* e. coli
* klebsiella
* proteus
* enterobacter
* pseudomonas
* acinetobacter
* h. influenzae
* moraxella catarrhalis
* neissera
* “bacters”
* “cocci”?

A

gram negative

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5
Q

What type of drug inhibits growth and replication of bacteria?

A

bacteriostatic

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6
Q

What type of drug actually kills bacteria and can be concentration OR time dependent?

A

bactericidal

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7
Q

What is essential to look at with time-dependent antibiotics?

A

time above lowest concentration of drug that can prevent growth of an organism (MIC = minimum inhibitory concentration)

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8
Q

What is essential to look at with concentration-dependent antibiotics?

A

Cmax/MIC ratio
AUC/MIC ratio

AUC = total amount of drug exposed to body over time

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9
Q

What is based on the time which bacteria are exposed to antibiotics at a concentration higher than MIC?

A

time-dependent abx

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10
Q

What is based on the rate and extent of killing increasing as peak drug concentration increases?

A

concentration dependent abx

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11
Q

What is the suppression of bacterial growth after limited exposure to abx?

A

post-antibiotic effect

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12
Q

What are common drugs that are concentration dependent abx?

A

aminoglycosides and fluoroquinolones

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13
Q

What are the first steps you need to take when addressing a pathogen?

A
  1. grow organism & evaluate w/ gram-stain
  2. identify specific organism
  3. determine sensitivity (MIC)
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14
Q

What type of antibiotic are PCNs, cephalosporins, carbapenems?

A

beta lactams

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15
Q

What type of abx MOA do
* beta lactams
* aztreonam
* glycopeptides
* lipopeptides
have?

A

cell wall inhibitors

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16
Q

Which drugs are bactericidal?

A
  • beta lactams
  • aztreonam
  • glycopeptides
  • lipopeptides
  • sulfonamides & trimethoprim
  • aminoglycosides
  • quinupristin/dalfopristin
  • fluoroquinolones
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17
Q

What type of abx MOA does sulfonamides/trimethoprim have?

A

folate antagonists

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18
Q

What type of abx MOA do
* aminoglycosides
* macrolides
* tetracyclines
* clindamycin
* linezolid
* quinupristin/dalfopristin
* chloramphenicol
* tigecycline
have?

A

protein synthesis inhibitors

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19
Q

What type of abx MOA does fluoroquinolones have?

A

inhibit DNA topoisomerases

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20
Q

We’re ECSTaTiC about bacteriostatic!

A

E - erythromycin
C-clindamycin
S-sulfamethoxazole
T- trimethoprim
a
T-tetracycline
i
C-chloramphenicol

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21
Q

Very Finely Proficient At Cell Murder

A

V-Vancomycin
F-fluoroquinolones
P-penicillin
A- aminoglycosides
C- cephalosporin
M- metronidazole

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22
Q

What type of spectrum are these drugs:
* 2nd gen cephs
* amoxicillin
* ampicillin
* metronidazole?

A

narrow

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23
Q

What type of spectrum are these drugs:
* 3rd gen cephs except ceftazidime
* amoxicillin/clauv
* ampicillin/sulbactam

A

broad

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24
Q

What type of spectrum are these drugs:
* ceftazidime
* 4th gen cephs
* anti-pseudomonal penicillins
* aztreonam
* ertapenem
* ceftraoline
* fluoroquinolones
* aminoglycosides
* colistimethate

A

extended

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25
Q

What type of spectrum are these drugs:
* anti-pseudomonal carbapenems
* tigecycline
* ceftazidime/avibactam
* ceftolozane/tazobactam
* impenem/cilastatin/relebactam
* meropenem/vaborbactam
* cefiderocol
* eravacycline

A

protected

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26
Q

Which drugs inhibit cell wall synthesis?

A
  • penicillins
  • cephalosphorins
  • carbapenems
  • monobactams
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27
Q

What is the MOA of beta lactams and monobactams?

A

competitive binding of transpeptidation enzymes which ultimately results in bacteria death. **Binds to penicillin binding proteins **

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28
Q

Are all beta lactams bactericidal?

A

Yes

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29
Q

How is resistance mediated through beta-lactams?

A

production of beta-lactamase (h.flu, MSSA, bacteroides, moraxella)
or alteration of PBPs (S.pneumoniae, MRSA)

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30
Q

What are ADRs of beta lactams/monobactams?

A
  • mild rashes to drug fever
  • nephritis, anaphylaxis
  • seizures from very high doses
  • accumulation can occur when not adjusted for renal function
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31
Q

What are amino-PCNS and which is parenteral versus oral?

A

parenteral: ampicillin
oral: amoxicillin

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32
Q

What are amino-PCNs AND beta-lactamase inhibitors and which is parenteral vs oral?

A

parenteral: ampicillin-sulbactam
oral: amoxicillin-clavulanate

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33
Q

What are anti-staph PCNs?

A

oxacillin, nafcillin, dicloxacillin (oral)

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34
Q

In what bacteria are PCNs reliable?

A

streptococci and treponema pallidum

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35
Q

In what bacteria are PCNs moderate?

A

enterococci & s. pnuemoniae

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36
Q

When are PCNs DOC?

A

syphilis, streptococcal pharyngitis (GAS)

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37
Q

What make all staphylococci resistant to penicillin?

A

penicillinases

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38
Q

Are PCNs a reliable empiric antibiotic choice?

A

No

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39
Q

In what bacteria are aminopenicillins reliable in?

A

enterococci and streptococci

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40
Q

In what bacteria are aminopenicillins moderate in?

A

h. flu, gram negative rods, and s/ pneumoniae

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41
Q

In what clinical utility are aminopenicillins used?

A

susceptible GNRs, upper respiratory tract infections

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42
Q

When is amoxicillin your PO DOC?

A

otitis media

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43
Q

When is ampicillin IV your DOC?

A

susceptible enterococci, and listeria monocytogenes

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44
Q

What requires addition of an aminoglycoside for synergy to become bacteriacidal?

A

bacteriostatic activity against enterococci

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45
Q

What are anti-staph penicillins also called?

A

penicillinase resistant

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46
Q

When are anti-staph PCNs reliable?

A

MSSA and strep

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47
Q

When are anti-staph PCNs moderate?

A

s. pneumoniae

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48
Q

When are anti-staph PCNs your drug of choice?

A

skin and soft tissue infections and endocarditis caused by MSSA

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49
Q

Why are anti-staph PCNS prefered over vancomycin for MSSA?

A

more rapidly bactericidal

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50
Q

If staphylococcus is sensitive to oxacillin, what else is it sensitive to?

A

ALL anti-staph PCNs AND amino-PCNs + BL-inhibitor AND most cephs (1st gens preferred)

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51
Q

What are examples of aminopenicillins?

A

ampicillin and amoxicillin

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52
Q

What are examples of beta-lactams that are beta-lactamase inhibitors?

A

ampicillin/sulbactam, amoxicillin/clavulanate, piperacillin/tazobactam and ticarcillin/clavulanate

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53
Q

In what are beta-lactams/beta-lactamase inhibitors reliable?

A

many anaerobes, enteric GNRs, enterococci, H. flu, MSSA, pseudomonas aeruginosa (only pip/tazo and ticarc/clav), strep

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54
Q

In what are beta-lactams/beta-lactamase inhibitors clinically utilized?

A

empiric therapy for nosocomial infections including pneumonia (only pip/tazo and ticarc/clav), intra-abdominal infections, diabetic ulcers, and aspiration pneumonia

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55
Q

In what are beta-lactams/beta-lactamase inhibitors moderate?

A

s. pneumoniae

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56
Q

What beta-lactams/beta-lactamase inhibitors only have moderate activity against enterococci?

A

ticarcillin/clavulanate

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57
Q

How do beta-lactamase inhibitors work?

A

restore activity of the antibiotic against B-lactamases producing bacteria
NO EFFECT on resistance caused by other mechanisms like MRSA or PCN-resistant pneumococci

58
Q

What are bacteriostatic oral MRSA treatment options?

A
  • clindamycin
  • doxycycline
  • linezolid
  • minocycline
  • tedizolid
59
Q

What are bacteriostatic IV MRSA treatment options?

A
  • linezolid
  • quinupristin/dalfopristine
  • tedizolid
  • tigecycline
  • clindamycin
  • doxycyline
60
Q

What are bactericidal oral MRSA treatment options?

A
  • trimethoprim/sulfamethoxazole
  • delafloxacin
61
Q

What are bactericidal IV MRSA treatment options?

A
  • cetaroline
  • dalbavancin
  • daptomycin
  • delafloxacin
  • oritavancin
  • telavancin
  • trimethoprim/sulfa
  • vancomycin
62
Q

What is the most common allergy reported by patients?

A

PCN - rash, GI intolerance is often reported, but not an allergy

63
Q

What is the MOA of cephalosporins?

A

binds to PCN binding proteins (PBPS)

64
Q

What’s more stable than PCN and aminoPCNs to b-lactamases?

A

cephalosporins

65
Q

How is resistance developed from cephalosporins?

A

altered PBPs = MRSA and B-lactamase degradation = GNRs

66
Q

What cephalosporin generation have good CNS penetration?

A

3rd and 4th potentially

67
Q

What are 3rd gen cephalosporins (CNS)?

A

ceftriaxone, ceftazidime, cefotaxime
meningitis

68
Q

What are first gen cephalosporins?

A

cefazolin + cephalexin PO

69
Q

What are second gen “respiratory” cephalosporins?

A

cefuroxime, cefuroxime axetil PO

70
Q

What are second gen “enterics” cephalosporins?

A

cefoxitin and cefotetan

71
Q

What are third gen cephalosporins?

A

ceftriaxone, cefixime PO,cefpodoxime PO, cefdinir PO, cefotaxime, ceftazidime

72
Q

What’s a fourth gen cephalosporin?

A

cefepime

73
Q

What’s a fifth gen cephalosporin?

A

ceftaroline

74
Q

What clinical activity are 1st gen cephalosporins reliable for?

A

MSSA, streptococci

75
Q

What clinical activity are 1st gen cephalosporins moderate for?

A

some enteric GNRs

76
Q

How are 1st gen cephalosporins clinically utilized?

A

SSTIs and endocarditis caused by MSSA, surgical prophylaxis, susceptible GNRs

77
Q

What should you NOT use for MSSA in the CNS?

A

1st gen cephalosporins

78
Q

What are 2nd gen “resp” cephalosporins reliable for??

A

some enteric GNRs, H. flu

79
Q

What are 2nd gen “resp” cephalosporins moderate for?

A

staph, strep

80
Q

where are 2nd gen “resp” cephalosporins clinically utilized?

A
  • activity against H. flu!! (differentiates)
  • URTIs, community acquired pneumonia w/macrolide or doxy
81
Q

What are 2nd gen enteric cephalosporins reliable for?

A

some enteric GNRs, h. flu

82
Q

What are 2nd gen enteric cephalosporins moderate for?

A

anaerobes, staph, strep

83
Q

Where are 2nd gen enteric cephalosporins clinically utilized?

A

abdominal and gynecologic infections, surgical prophylaxis
activity against bacteroides fragilis

84
Q

What are ADRs for 2nd gen enteric cephalosporins?

A

disulfiriam-like reaction when w/ ethanol

85
Q

What are 3rd gen cephalosporins reliable for?

A

enteric GNRs, pseudomonas (ceftazidime ONLY), strep

86
Q

What are 3rd gen cephalosporins moderate for?

A

MSSA (NOT ceftazidime or ceftixime)

87
Q

In what are 3rd gen cephs clinically utilized?

A

community acquired pneumonia (+macrolide and doxy), UTIs, lyme disease (ceftriaxone)
nosocromial infections, febrile neutropenia (ceftazidime ONLY)

88
Q

When are 3rd gen cephalosporins your DOC?

A

gonorrhea and meningitis (ceftriaxone)

89
Q

How are 3rd gen cephalosporins better?

A

more active against GNRs from previous generations and some PCN-resistant S.pneumoniae (NOT cefixime or ceftazidime)

90
Q

What are 4th gen cephs reliable for?

A

enteric GNRs, MSSA, pseudomonas, strep and MRSA

91
Q

What are 4th gen cephs moderate for?

A

acinetobacter

92
Q

How are 4th gen cephs clinically utilized?

A

febrile neutropenia, nosocomial infections (pneumonia), meningitis

93
Q

How are 4th gen cephs better?

A

better staph/strep activity, active against some PCN-resistant S. pneumoniae

94
Q

Where are 5th gen cephs reliable?

A

enteric GNRs, MSSA, MRSA, strep

95
Q

Where are 5th gen cephs moderate?

A

acinetobacter, enterococcus faecalis

96
Q

How are 5th gen cephalosporins clinically utilized?

A

approved for SSTI and community-acquired pneumonia

97
Q

How are 5th gen cephs better?

A

additional MRSA coverage and E.faecalis activity

98
Q

What is ceftolozane-tazobactam used for?

A

intra-abdominal infections and UTIs

99
Q

What does ceftolozane-tazobactam cover?

A

ESBL coverage and most active B-lactam for pseudomonas
no staph or entero coverage

100
Q

What is ceftazidime-avibactam used for?

A

intra-abdominal infections and UTIs; new type of B-lactamase inhibitor

101
Q

What are examples of carbapenems?

A
  • imipenem/cilastatin
  • meropenem
  • doripenem
  • etrapenem
102
Q

Where are carbapenems clinically reliable?

A
  • MSSA
  • streptococci
  • anaerobes
  • enteric GNRs
  • psuedomonas (NOT ertapenem)
  • acinetobacter (not ertrapenem)
103
Q

Where are carbapenems moderate?

A

enterococci (NOT ertapenem)

104
Q

How are carbapenems clinically utilized?

A
  • mixed aerobic/anaerobic infections, infections caused by ESBL organisms, intra-abdominal infections
  • nosocomial pneumonia, febrile neutropenia, other nosocomial infections (NO ERTAPENEM)
105
Q

When are carbapenems your DOC?

A

ESBL-producing GNRs

106
Q

does aztreonam have gram positive activity?

A

NO

107
Q

What’s an example of a monobactam?

A

aztreonam

108
Q

What are monobactams reliable for?

A

most GNRs, pseudomonas

109
Q

What are monobactams moderate for?

A

acinetobacter

110
Q

When are monobactams clinically utilized?

A

gram negative infections, pseudomonas, often used in patients with severe allergies to B-lactams

111
Q

When shoud you avoid all PCNS?

A

in setting of anaphylaxis and up to 40% cross in rash/hives

112
Q

What are the best to use with side chain cross-reactivity?

A

monobactams

113
Q

What cephalosporins should be avoided in patients with true PCN allergies?

A
  • cefaclor
  • cefadroxil
  • cefatrizine
  • cefprozil
  • cephalexin
  • cephradine
114
Q

If a patient can safely recieve a cephalosporin, should you give that or carbapenem?

A

cephalosporin! carbapenem should be reserved.

115
Q

What are oral psuedomonas treatment options?

A
  • ciprofloxacin
  • levofloxacin
  • norfloxacin
  • ofloxacin
116
Q

What are IV pseudomonas treatment options?

A
  • aminoglycosides
  • piperacilling-tazobactam
  • ceftazidime/ceftazidime
  • cefepime
  • ceftolazoane
  • impenem, meropenem, doripenem
  • colostin
117
Q

What are nebulized pseudomonas treatment options?

A
  • aztreonam
  • colistin
  • tobramycin
118
Q

Which drugs have no need for renal dose adjustment?

A

ceftriaxone and nafcillin

119
Q

What’s a glycopeptide?

A

vancomycin

120
Q

What’s a lipopeptide?

A

daptomycin

121
Q

What are glycopeptides MOA?

A
  • bactericidal (Conc. dependent)
  • inhibits cross-linking of linear peptidoglycans
  • MONITOR DRUG LEVELS
122
Q

What are ADRs of glycopeptides?

A

nephrotoxicity, red man syndrome, rare ototoxicity

123
Q

When are glycopeptides reliable?

A

MSSA (not first choice), MRSA, strep, c. diff

124
Q

When are glycopeptides moderate?

A

enterococci

125
Q

When are glycopeptides clinically utilized?

A

empiric treatment for pneumococcal meningitis, MSSA (allergy)

126
Q

When are glycopeptides the DOC?

A

all MRSA, or empiric MRSA coverage, severe C.diff
PO = not absorbed by GI tract, not systemically distributed

127
Q

What are lipopetide MOA?

A

bactericidal - conc dependent
binds to membrane, depoloarizes, loss of membrane potential
Avoid in pneumonia

128
Q

What are ADRs of lipopeptide?

A

rhabdomyolosis (check CK), hepatic effects (dose dependent)
avoid with statins!!

129
Q

When are lipopeptides clinically reliable?

A

MSSA, MRSA, strep

130
Q

When are lipopeptides reliable to moderate?

A

enterococci (VRE)

131
Q

When are lipopeptides clinically utilized?

A

SSTIs and staphylococcal bacteremia/endocarditis

132
Q

Buy AT 30, CCELL for 50 dollarS
“Protein synthesis inhibitors”

A

Inhibitors of 30
* aminoglycosides
* tetracyclines

inhibitors of 50
* clindamycin
* chloramphenicol
* erythromycin
* linomycin
* linezolid
* streptogramins

133
Q

What are protein synthesis inhibitors of 30s?

A
  • aminoglycosides
  • tetracyclines
134
Q

What are protein synthesis inhibitors of 50s?

A
  • clindamycin
  • chloramphenicol
  • erythromycin
  • lincomycin
  • linezolid
  • streptogramins
135
Q

What are major toxic effects of aminoglycosides?

A

ototoxicity and nephrotoxicity

136
Q

What are examples of aminoglycosides?

A

getamicin, tobramycin, amikacin

137
Q

What’s the MOA of aminoglycosides?

A

inhibit protein synthesis with 30s unit
Must monitor drug levels
rarely used as single drug therapy!
bactericidal conc dependent

138
Q

What should you do for long term AG use?

A

baseline and follow up with audiology

139
Q

Can neuromuscular blockade occur with AGs?

A

Yes, in high doses

140
Q

When are aminoglycosides reliable?

A

GNR, pseudomonas

141
Q

When are aminoglycosides utilized clinically?

A

combo w/ other abx for serious infections: febrile neutropenia, sepsis, CF, ventilator-associated pneumonia

142
Q

What’s used for synergy with B-lactams or vanc for gram+ infections (no coverage as mono)?

A

aminoglycosides

Clinical Pharmacology (9 decks)

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