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Clin Therapeutics 1 > Exam 1 - ABX (classes, groups, dynamics, etc) > Flashcards

Exam 1 - ABX (classes, groups, dynamics, etc) Flashcards

1
Q

All Beta-Lactams are ______ and dependent on what?

A

Bacteriocidal, time dependent

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2
Q

Which two classes of abx are concentration dependent?

A

Aminoglycosides, Fluoroquinolones

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3
Q

Which class of abx are AUC:MUC?

A

Vancomycin

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4
Q

What are the four classes of Beta-Lactam antibiotics?

A
  1. PCN
  2. Cephalosporins
  3. Carbapenems
  4. Monobactam
    M.C.C.P (mass college college pharmacy)
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5
Q

Beta-Lactam MOA?

A

Inhibits Penicillin Binding Proteins. Breaks peptides cross-linkages and prevention peptidoglycan structures.

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6
Q

Beta-Lactam abx are bacteriocidal against all except for which one?

A

Enterococcus

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7
Q

Beta-Lactams are excreted how? Which three are not?

A

Excreted renally.

Except for Ceftriaxone, Oxacillin, Naficillin (C.O.N.)

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8
Q

4 methods of resistance to Beta-Lactams abx?

A

Inactivated
Modification of PBP
Low or decreased affinity for PBP
Efflux channel pumps

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9
Q

Which gram bacteria typically resist Beta-Lactams by inactivation?

A

Gram Negative bacteria. Makes Beta-Lactamase enzyme.

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10
Q

What is the most common type of resistance of Gram Negative bacteria?

A

Beta-Lactamase enzyme to inactivate Beta-Lactam abx

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11
Q

How to overcome inactivation resistance to Beta-Lactams?

A

Add Beta-Lactam Inhibitors (BLI) to bind do Beta-Lactamase enzyme.

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12
Q

Three ways to overcome resistance to Low or Decreased Affinity to PBPs with Beta-Lactams?

A

High dose Amoxicillin, switch to Cephalosporins, or Carbapenems

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13
Q

Low or Decreased Affinity to PBPs with Beta-Lactams occurs with which bacteria?

A

Streptococcus Pneumoniae

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14
Q

Which two bacteria modify their PBPs to resist Beta-Lactam abx?

A

MRSA, Penicillin-resistant strep pneumoniae

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15
Q

What happens to Vancomycin and gram negative bacteria?

A

Too large to transport through the outer envelope. Can’t reach target site.

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16
Q

What do Efflux Channels do to bacteria resistant to Beta-Lactams?

A

Pump out the abx across the membrane

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18
Q

Beta-Lactamase Inhibitor MOA?

A

Inhibits some but not all Beta-Lactmases. Binds to Beta-Lactamse which prevents breakdown of parent drug.

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19
Q

What is and does Beta-Lactmase?

A

Bacterial enzyme which inactivates Beta-Lactam abx

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20
Q

What does Beta-Lactamase Inhibitor bind to?

A

Binds to Beta-Lactamase enzymes and prevents destruction of parent drug.

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21
Q

Three common formulations of Beta-Lactam abx + BLI?

A
  1. Amoxicillin + Clavulanic Acid (Augmentin)
  2. Ampicillin + Sublactam (Unasyn)
  3. Pipericillin + Tazobactam (Zosyn)
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22
Q

What are the 4 Penicillin classes?

A
  1. Natural PCN
  2. Antistaphylococcal (Penicillinase Resistant)
  3. Amino Penicillin (+/- Beta-Lactamase-Inhibitors)
  4. Antipseudomonal agents (3rd and 4th Cephalosporins, + Beta-lactamase Inhibitor)
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23
Q

Spectrum of the 4 Penicillin classes?

A 
NARROW SPECTRUM
1. Natural PCN 
2. Antistaphylococcal
3. Amino Penicillin
4. Antipseudomonal agents (3rd and 4th Cephalosporins, + Beta-lactamase Inhibitor)
BROAD SPECTRUM
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24
Q

Which Penicillin class is the most narrow? Most broad?

A

Narrow=Natural PCN

Broad=Antipseudomonal agents (3rd and 4th generation Cephalosporins)

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25
Q

What is the spectrum coverage for Natural PCN?

A

Gram + Aerobes Staph and Strep A, B, C, D, E, F, G

Gram + Anaerobes

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26
Q

What two common sites of infection is Natural PCN used for?

A

Dental infections

Throat infections

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27
Q

What are the two drugs in the Natural PCN class?

A

PenG, PenV

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28
Q

What are the three drugs in the Antistaphylcoccal PCN class?

A

Nafacillin, Oxacillin, Dicloxacillin

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29
Q

What are Antistaphylcoccal PCNs great at covering?

A

MSSA

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30
Q

What body side are Antistaphylcoccal PCNs good at treatment?

A

Skin infections

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31
Q

What are the two drugs in the Amino PCN class?

A

Amoxicillin, Ampicillin

32
Q

What is the gold standard for Listeria?

A

Ampicillin

33
Q

What are the three drugs in the Antipseudomonal PCN class?

A

Amoxicillin + Clavulanate (Augmentin)
Ampicillin + Sublactam (Unasyn)
Piperacillin + Tazobactam (Zosyn)

34
Q

What two drug groups make up the Antipseudomonal class of PCNs?

A

Amino PCN + Beta-Lactamase-Inhibitor (BLI)

35
Q

Beta-Lactam + BLI treats bacteria doing what?

A

Bacteria making Beta-Lactamase

MSSA, H. Flu, E. Coli, M. Catt, P. Mira

36
Q

What are the six classes of Cephalosporins?

A

1st gen, 2nd gen, 3rd gen, 4th gen, 5th gen, Cephalosporin+BLI

37
Q

What happens to the spectrum of Cephalosporins as it goes up?

A

Spectrum goes from narrow to broad

Ex: 1st gen is very narrow in coverage, Cephalosporins + BLI is broad.

38
Q

What gram of bacteria do early generation Cephalosporins cover?

A

Cover Gram + broadly, cover Gram - narrowly

39
Q

Which Cephalosporin generation and drug covers Pseudomonas?

A

3rd gen. Ceftaz.

40
Q

Which cephalosporin generation and drug covers MSSA and MRSA?

A

5th gen. Ceftaroline.

41
Q

What do the Carbapenems class of antibiotics end in?

A

“-penem”

42
Q

What are the Carbapenems the drug of choice for?

A

For Ceftriaxone-resistant E. Coli, Klebsiella, and P. Mirabillis

43
Q

What is the spectrum of the Carbapenems?

A

Gram Positive staph, strep, and E. Faecelis
Gram Negative including P. Aeruginosa
Anaerobes

44
Q

What two bacteria does Enterapenem not cover?

A

E. Faecelis (gram +)

P. Auerginosa (gram -)

45
Q

What can Imipenem cause at high doses?

A

Seizures

46
Q

Carbapenems are useful for organisms that are what? Drug of choice for what?

A

Very resistant organisms.

Drug of choice for ESBL (Extended Spectrum Beta-Lactamase)

47
Q

What is the only drug and route in the Monobactam class?

A

Aztreonam IV

48
Q

What is the coverage of Monobactam (Azetreonam IV)?

A

Gram Negative Aerobic

49
Q

Which drug is limited to Gram Negative Aerobic coverage?

A

Azetreonam IV (the one and one Monobactam)

50
Q

What is the claim to fame of the Monobactam class (Azetreonam)?

A

Pseudomonas coverage for the PCN-allergic person

51
Q

What class is Azetreonam in?

A

Monobactam

52
Q

What route for CSF penetration?

A

IV

53
Q

What two abx for cystitis?

A

Nitrofurantoin, Fosfomycin

54
Q

What are three “problematic agents” for the lungs?

A
  1. Aminoglycosides
  2. Daptomycin
  3. Vancomycin
    (VAD…these are “vad” for the lungs”)
55
Q

What is compromising about abscesses?

A

Compromises abx drug levels

56
Q

What are the three possible routes for abx excretion? (Hint: one is a combo)

A

Renal, hepatic, or both.

57
Q

What will happen to Nitrofurantoin if CrCl is less than 50?

A

Will lack efficacy

58
Q

Which four abx don’t require dose adjustment in the present of end-organ damage?

A
  1. Ceftriaxone
  2. Naficillin
  3. Oxacillin
  4. Linezolid
    (C.N.O.L)
59
Q

Most abx are in which two possible pregnancy categories?

A

B or C

B=animal studies show safe to fetus
C=animal studies show some danger to fetus

60
Q

What three categories of abx to often avoid in pregger women?

A
  1. Fluoroquinolones
  2. Sulfamethoxazole-Trimethoprim
  3. Tetracyclines
    (F.S.T….don’t get preggers too fast)
61
Q

Which abx to avoid in kids under 8? Why?

A

Tetracycline. Effect on bones and teeth.

62
Q

Which class of abx should be avoided in young children due to poor formation of cartilage?

A

Fluoroquinolones

63
Q

What is the general rule for kids and abx?

A

Use older agents due to more clinical experience with them.

64
Q

Three bad effects from Fluoroquinolones?

A
  1. QTc prolongation
  2. Tendon rupture
  3. Mental status change
65
Q

Big risks with Macrolides?

A
  1. QTc prolongation

2. Risk of sudden cardiac death

66
Q

Risk of what with Beta-Lactams and kids? Due to what?

A

Seizures. Due to improper renal adjustment dosing

67
Q

What is the cross-reactivity percent between PCN and Cephalosporins?

A

Historically 10-15%, closer to 5% now

68
Q

What is the cross-reactivity percent between PCN and Carbapenems?

A

9.5-50% in skin test and retrospective reviews.

69
Q

What percent of patients with PCN-positive skin test will react to therapeutic Carbepenem?

A

1%

70
Q

In a patient with a less severe reaction to PCN such as a mild rash what are two available options?

A
  1. Cephalosporins

2. Carbapenems

71
Q

What is Aztreonam not an option for a PCN allergic patient?

A

When allergic to Ceftazidime

72
Q

What is a major factor in C. Diff Infection (CDI)?

A

Antibiotic use. More than 3 abx increases risk.

73
Q

Risk of C Diff Infection (CDI) doubles after how long?

A

After 3 days of antibiotic therapy

74
Q

Which abx have the same PO and IV bioavailability?

A 
Azithromycin 
Bactrim 
Clindamycin 
Doxycycline 
Fluoroquinolones 
Linezolid 
Metronidazole
(A.B.C.D.F.L.M)
75
Q

Pseudomonas in the eyes usually due to what?

A

Contact lenses not being cleaned/changed

Clin Therapeutics 1 (12 decks)

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