which carbapenem is Very resistant to beta-lactamase? - Imipenem/cilastin (combo drug) - Meropenem

- Imipenem/cilastin (combo drug) (normally carbapenems aren’t but this is a combo drug)

exam 1a drugs Flashcards by Garrett Anderson

which tetracyclines is this -Tetracycline, Doxycycline, Minocycline

Neisseria meningitides – meningococcus is a bacterium that can cause bacterial meningitis, a serious infection of the lining of the brain and spinal cord.
Decreases s/s of rheumatoid arthritis
ER form for acne = solodyn

Minocycline

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which carbapenem is Very resistant to beta-lactamase?

Imipenem/cilastin (combo drug)
Meropenem

Imipenem/cilastin (combo drug) (normally carbapenems aren’t but this is a combo drug)

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Macrolides: Erythromycin vs Azithromycin

Has beneficial effect on gastroparesis (a condition characterized by delayed gastric emptying)
- Hypomotility refers to a decrease in the movement of the digestive tract
- Stimulates gastric motility: _________ can stimulate the muscles in the stomach wall to contract more forcefully
- Improves gastric emptying: By increasing stomach motility,

Erythromycin

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which carbapenem is this

Less coverage compared
Gram +
Gram –
Aerobes
Anaerobes

side effects
- Rash
- Diarrhea
- Less seizure activity

Doesn’t degrade in kidneys

Imipenem/cilastin or Meropenem?

Meropenem

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which tetracyclines is this -Tetracycline, Doxycycline, Minocycline

s/e
- Teeth damage
- (kids < 8)
- n/v/d
- headache
- photosensitivity
- dizzy
- anaphylaxis
- angioedema

Route = PO only
- Absorption isn’t great even when fasting
- Giving higher dose decreases amount absorbed

Drug will concentrate in/on
- Bone
- Liver
- Tumor
- Spleen
- Teeth!! (causes damage to kids < 8)

Tetracycline (class and drug name)

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which cephalosporins generation

MRS
MSSA
Some VRSA/VISA
No Enterobacter, pseudomonas, ESBL, klebsiella coverage

Renally dosed medication - mainly excreted from the body through the kidneys. dosage and frequency must be adjusted based on a patient’s kidney function.

Route = IV only

5th generation
Ceftaroline

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which PCN is
- Common treatment for infections = ear, nose, throat, GU, skin
- Very common in peds
- PO only
- less side effects

amoxicillin or ampicillin?

amoxicillin (PCN: aminopenicillin)

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Macrolides: Erythromycin vs Azithromycin

which has some advantages in coverage?

which has less GI upset?

both Azithromycin

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treat with abx or antiviral?

which one?

Influenza A
Some action against influenza B
Prophylaxis
Active disease (if given within 48 hrs of onset of s/s)
Swine flu

antiviral

oseltamivir = flu

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Do not take on empty stomach – severe GI upset!!

Do not take with food – decreases absorption

Macrolides: Erythromycin vs Azithromycin

E - Do not take on empty stomach – severe GI upset!!

A - Do not take with food – decreases absorption

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which cephalosporins generation

gram –
gram + (much less activity)

route = IV, IM, PO

_______________ - Works for pseudomonas (common bacterium)

_____________- Able to cross BBB (works on meningitis, other CNS infections)
- Do not give to pts with liver failure
- Extremely long acting
- 1 dose per day

3rd generation
Ceftriaxone
Ceftazidime
Cefotaxime

Ceftazidime - Works for pseudomonas (common bacterium)

Ceftriaxone - Able to cross BBB (works on meningitis, other CNS infections)
- Do not give to pts with liver failure
- Extremely long acting
- 1 dose per day

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which abx is this - Macrolides: Erythromycin, Azithromycin or Tetracyclines: Tetracycline, Doxycycline, Minocycline?

Bactericidal or bacteriostatic (depends on drug concentration)

Inhibit protein synthesis by binding to ribosomes

“YUCK” drugs bc of severe GI s/e

works on
- URI
- LRI
- Skin infection s
- Soft tissue infections
- STI
- Legionnaires, listeria, mycoplasma PNU

Macrolides: Erythromycin, Azithromycin

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treat with abx or antiviral?

which one?

cytomegalovirus (CMV) - common herpesvirus that infects most people at some point in their lives.

While it usually causes no symptoms in healthy individuals, CMV can be serious for people with weakened immune systems or newborns.

antiviral

ganciclovir

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which PCN is
- not broken down by the penicillinase enzyme, which some bacteria produce to resist the effects of penicillin (penicillinase resistant)
- IV only

nafcillin or amoxicillin?

nafcillin (penicillinase resistant)

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which has less side effects amoxicillin or ampicillin?

amoxicillin

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which antiviral has these BLACK BOX WARNINGS
1. Hematologic toxicity
2. Fertility impairment
3. Fetal toxicity
4. Carcinogenesis

Acyclovir, ganciclovir, Oseltamivir

ganciclovir

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Gentamycin
Amikacin
Tobramycin

are these Aminoglycosides or Lincosamides?

Aminoglycosides

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Macrolides: Erythromycin vs Azithromycin

Broad spectrum
Does not cross BBB
Has beneficial effect on gastroparesis

Route
- PO – oral absorption is not great
- IV – painful
- Topical
- Ophthalmic

Do not take on empty stomach – severe GI upset!!

Lots of drug/drug interactions

Erythromycin
Antimicrobial MOA: DNA/RNA disruption

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which PCN is
- least toxic
- half life 30 min (with good kidney function)
- works on gram + and -
- works on anaerobic bacteria
- can be combined with vancomycin

nafcillin or G & V?

natural

G and V

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which PCN is
- Widest spectrum
- good for pseudomonas infection
- ALWAYS give with beta lactamase inhibitor
- Affects platelet function
- Monitor for renal dysfunction

piperacillin or amoxicillin?

PCN: extended spectrum
piperacillin

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which abx is this - Lincosamides:
Clindamycin or Nitroimidazoles: Metronidazole?

Inhibits DNA synthesis

works on
- Crohns disease
- C Diff
- Anaerobic activity only
- Antiprotozoal - used to treat infections caused by protozoa
- antibacterial

s/e
- n/v
- xerostomia – dry mouth
- vaginal candidiasis – yeast infection

Do not take with alcohol
- Toxic
- No alcohol 24 hr before med
- No alcohol 36 hr after med

Nitroimidazoles: Metronidazole

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which carbapenem is this
- MOST broad spectrum of all
- BBB and meninges
- Complicated infections
- Very resistant to beta-lactamase
- Watch for seizures (especially in OA and in combo with other meds that can induce seizures)
- Route = IV only

Imipenem/cilastin or Meropenem?

Imipenem/cilastin (combo drug)

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antibiotics or antivirals?

Acyclovir
Oseltamivir
ganciclovir

antivirals (non-HIV)

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which Fluoroquinolones: Ciprofloxacin or Levofloxacin is this?

works on
- UTI
- STI
- LRI, URI
- Gonorrhea
- Minimal penetration of BBB/CSF
- Rapid and slow growing organisms
- Anthrax – infection with bacillus anthracis

s/e
arthropathy – joint disease

Route = PO, IV, topical

avoid in young and old patients (< 18 and > 60)

Prolonged post-antibiotic effects

ability to concentrate in neutrophils

Ciprofloxacin

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which abx is this? Lincosamides: Clindamycin or Macrolides: Erythromycin, Azithromycin? Bactericidal or bacteriostatic (depends on drug concentration) works on - Chronic bone infection - GU tract infection - Intraabdominal infections - Anaerobic PNU - Septicemia - Serious skin infections - Prophylaxis for endocarditis side effects - Deadly pseudomembranous colitis - Monitor for use with neuromuscular blockade meds - Monitor levels (very toxic) Route = PO, IV Wont work on VRE, CRE, etc.

Lincosamides: Clindamycin

which cephalosporins generation - gram + - gram – _________ doesn’t work on anerobic bacteria route = PO or IV

2nd generation Cefotetan Cefuroxime - doesn’t work on anerobic bacteria

which cephalosporins generation - Gram – - Gram + - Broad spectrum - UTI, skin infection, pneumonias - Cross BBB

4th generation Cefepime

whats the only glycopeptide antibiotic with MOA Cell wall disruption we learned?

vancomycin

which antibiotic causes - Flushing - Rash - Pruritis - Urticaria - Tachycardia - Hypotension when infused too fast?

vancomycin (red man syndrome)

which antiviral is this? Acyclovir, ganciclovir, Oseltamivir Stops neuraminidases in influenza viruses (enzymes produced by influenza virus that plays a crucial role in the viral life cycle, particularly in the release of new virus particles from infected cells) works on - flu - Influenza A - Some action against influenza B - Prophylaxis - Active disease (if given within 48 hrs of onset of s/s) - Swine flu s/e - n/v - seizures - renal impairment Usually only give to elderly and immunocompromised patients after known exposure to influenza A and B Route = PO only

Oseltamivir

which abx is this - Macrolides: Erythromycin, Azithromycin or Tetracyclines: Tetracycline, Doxycycline, Minocycline? s/e - Tooth enamel hypoplasia and discoloration of teeth in fetus and children - Photosensitivity - Many others Contraindications - Pregnant or nursing - Kids < 8

Tetracyclines: Tetracycline, Doxycycline, Minocycline tetracyclines = TEETH

the 2 PCN: aminopenicillin drugs are

amoxicillin and ampicillin

Macrolides: Erythromycin vs Azithromycin Differs structurally from other macrolides Has some advantages in coverage compared to - Tissue penetration - Long duration of action Less GI upset compared to Do not take with food – decreases absorption

Azithromycin Antimicrobial MOA: DNA/RNA disruption

which abx is this - Fluoroquinolones: Ciprofloxacin, Levofloxacin or Sulfonamides: Sulfamethoxale + trimethoprim (combo drug called Bactrim) - MOA: Prevents the synthesis of folic acid needed for DNA synthesis - bacteriostatic works on - UTI - Respiratory infections - Salmonella - Shigellosis - HIV s/e Photosensitivity Check for sulfa allergy

Sulfonamides: Sulfamethoxale + trimethoprim (combo drug called Bactrim)

antivirals for herpes = flu = cytomegalovirus (CMV) = Acyclovir ganciclovir Oseltamivir

herpes = acyclovir flu = oseltamivir cytomegalovirus (CMV) = ganciclovir

which class of abx do these belong to Doxycycline Minocycline Tetracyclines or Fluoroquinolones ?

Tetracyclines: Tetracycline Doxycycline Minocycline

which abx is this? Amnioglycosides or carbapenums? - Gram – - Gram + (with other antibiotics for best effect) - Complicate infections - UTI - Peritonitis - Endocarditis - PNA - Osteomyelitis - DM related infection side effects - Severe - Nephrotoxicity (reversible) - Ototoxicity (permanent) - Requires peak and trough to monitor therapeutic drug levels - Transition from 3x/day to 1x/day dosing

Aminoglycosides: Gentamycin Amikacin Tobramycin

which tetracyclines is this -Tetracycline, Doxycycline, Minocycline work on - chlamydial infection - mycoplasma infection - prophylaxis for STI - acne - skin infections

Doxycycline

s/e for PCN or cephalosporins? - Urticaria - hives - Pruritis - Angioedema – swelling

PCN

treat with abx or antiviral? which one? works on - HSV 1 – oral - HSV 2 – genital - VZV – shingles and chicken pox - Initial infection - Recurrent infection

antiviral herpes = acyclovir

which Fluoroquinolones: Ciprofloxacin or Levofloxacin is this? Prolonged post-antibiotic effects – concentrated in the neutrophils - continued antimicrobial activity of ___________ even after its serum levels have fallen below the minimum inhibitory concentration (MIC). This means that the antibiotic can still effectively kill bacteria even after it is no longer detectable in the blood. - ability to concentrate in neutrophils, a type of white blood cell that plays a crucial role in the immune system.

Ciprofloxacin

which antiviral is this? Acyclovir, ganciclovir, Oseltamivir MOA - Interferes with: viral nucleic acid synthesis, regulation, or DNA/RNA - Prevents: virus from binding to cells so virus cant get into cells to replicate - Stimulates: the body’s immune system to kill the virus works on - herpes - HSV 1 – oral - HSV 2 – genital - VZV – shingles and chicken pox - Initial infection - Recurrent infection s/e - GI distress - Renal impairment - Seizures - ITP - Tissue necrosis (if IV not patent) Route = PO, topical, IV Not a cure!! But helps decrease symptom severity, duration, and frequency

herpes = acyclovir

which beta lactam abx are these drugs? Imipenem/cilastin (combo drug) Meropenem

Carbapenems

which abx is this - Fluoroquinolones: Ciprofloxacin, Levofloxacin or Sulfonamides : Sulfamethoxale + trimethoprim (combo drug called Bactrim) Broad spectrum PO good absorption works on - Gram – - Some gram +

Fluoroquinolones: Ciprofloxacin, Levofloxacin

which antibiotic is this? - Gram + - MRSA - PCN resistant pneumococcus - doesn’t work on CNS infections PO - C. diff - Pseudomembranous colitis Toxic – - Ototoxicity – hearing (reversible) - Thrombocytopenia - Nephrotoxic – watch use with other kidney affecting drugs - Watch with neuromuscular blockades (paralyzers) - Redman syndrome - Kidneys eliminate drug Reduce dose for renal dysfunction - Infuse slow and long or redman syndrome can occur

vancomycin

which antiviral is this? Acyclovir, ganciclovir, Oseltamivir Inhibits viral DNA polymerases = stops replication works on cytomegalovirus (CMV) Don’t give with antibiotic/antimicrobial imipenem-cilastin (carbapenem) = seizure potential Watch kidney function if giving with other nephrotoxic drugs Only given to immunocompromised patients - AIDS - Immunosuppression - Transplants Not a cure!! But it helps control it Route = IV, PO BLACK BOX WARNINGS 1. Hematologic toxicity 2. Fertility impairment 3. Fetal toxicity 4. Carcinogenesis

ganciclovir

which beta lactam abx is this - Broadest spectrum of ALL antibiotics - Last resort medication - s/e Drug induced seizure - Route = IV only Over 60 mins

Carbapenems - Imipenem/cilastin (combo drug) - Meropenem

beta lactam antibiotics (treats bacterial infections for bacteria that doesn’t produce beta lactamase (enzyme)? PCN cephalosporins carbapenems vancomycin

PCN cephalosporins carbapenems vancomycin = glycopeptide antibiotic

which carbapenem has more coverage Imipenem/cilastin or Meropenem?

Imipenem/cilastin

which aminoglycoside has these additional side effects - Severe respiratory distress - CNS – confusion, depression, disorientation, numbness and tingling - Cochlear damage all of them have these s/e - Severe - Nephrotoxicity (reversible) - Ototoxicity (permanent) Gentamycin, Amikacin, or Tobramycin?

gentamycin

which cephalosporins generation - gram + - staph infection s - non-enterococcal strep infection s common for surgical prophylaxis PO or IV

1st Cephalexin Cefazolin - (IV only), common for surgical prophylaxis

which class/drugs is this - Macrolides: Erythromycin, Azithromycin or Tetracyclines: Tetracycline, Doxycycline, Minocycline? Bacteriostatic Inhibit protein synthesis by binding to ribosomes Broad spectrum Major resistance has developed works on - Tick diseases - Chlamydia - Trichomonas - Cholera - PID - Mycoplasma PNU - Acne s/e - Tooth enamel hypoplasia and discoloration of teeth in fetus and children - Photosensitivity - Many others Contraindications - Pregnant or nursing - Kids < 8

Tetracyclines: Tetracycline, Doxycycline, Minocycline

which Fluoroquinolones: Ciprofloxacin or Levofloxacin is this? - most widely used of this class - broad spectrum (but only requires 1x/day dosing) - less resistant side effects - CNS disorders w/ predisposition to seizures - Kidney failure - Prolongation of QT interval - Photosensitivity route = - PO – 100% bioavailability - IV

Levofloxacin

which generations: cefazolin cephalexin cefuroxime cefotetan Ceftriaxone Ceftazidime Cefotaxime Cefepime Ceftaroline

1st cefazolin cephalexin 2nd cefuroxime cefotetan 3rd Ceftriaxone Ceftazidime Cefotaxime 4th Cefepime 5th Ceftaroline

antibiotics or antivirals? MOA: inhibit cell wall synthesis or DNA/RNA disruption? penicillin cephalosporins carbapenems vancomycin

Antibiotics/antimicrobials MOA: Inhibit cell wall synthesis

which beta lactam abx is - Low toxicity - poor oral absorption side effects: - Diarrhea - Abdominal cramps - Rash - Pruritis - Redness - Edema PCN or cephalosporins?

cephalosporins PCN side effects = just skin

antibiotics or antivirals? MOA: inhibit cell wall synthesis or DNA/RNA disruption? Aminoglycosides: Gentamycin Amikacin Tobramycin Lincosamides: Clindamycin Macrolides: Erythromycin Azithromycin Tetracyclines: Tetracycline Doxycycline Minocycline Fluoroquinolones: Ciprofloxacin Levofloxacin Sulfonamides : Sulfamethoxale + trimethoprim (combo drug called Bactrim) Nitroimidazoles: Metronidazole

Antimicrobials/antibiotics MOA: DNA/RNA disruption

which PCN is - broad spectrum - side effects - diarrhea and rash route = PO, IV - renal sensitive - can be combined with sulbactam to treat resistant bacteria amoxicillin or ampicillin?

ampicillin (PCN: aminopenicillin)

T/F 1. Ganciclovir can be given give with carbapenem? 2. ampicillin can be combined with sulbactam to treat resistant bacteria? 3. Tetracyclines can be given to kids under 8? pregnant women? 4. PCN G and PCN V can be given with aminoglycosides (GAT)? 5. always give piperacillin with beta lactamase inhibitor? 6. do not drink alcohol with Metronidazole?

1. F = seizure potential 2. T 3. F = contraindications 4. T 5. T 6. T

amoxicillin-clavulanic acid (combo drug) clavulanic acid ____________ making the amoxicillin more effective

clavulanic acid inhibits beta lactamase making the amoxicillin more effective

vancomycin aminoglycosides (GAT) tetracyclines macrosimides (AE) which s/e should we watch for? - teeth discoloration - hearing loss - GI upset - redman syndrome

aminoglycosides (GAT) - hearing loss tetracyclines - teeth discoloration macrosimides (AE) - GI upset vancomycin - redman syndrome

which ones would be prescribed for UTI? - metronidazole - levoflaxacin - ciprofloxacin - tetracycline - sulfamethoxale + trimethoprim

- ciprofloxacin - sulfamethoxale + trimethoprim

clindamycin s/e - Deadly pseudomembranous colitis - Monitor for use with neuromuscular blockade meds - Monitor levels (very toxic) should a patient with a history of c diff be given this med?

No bc pseudomembranous colitis is caused by c diff and a history of c diff would be a contraindication

Renal (kidney) sensitive PCN

ampicillin

- Affects platelet function - Monitor for renal dysfunction - ALWAYS give with beta lactamase inhibitor

piperacillin

(Avoid if anaphylaxis reaction occurs with PCN)

Cephalosporins

Cephalosporins - Do not give to pts with liver failure

3rd generation Ceftriaxone

Cephalosporins - Renally dosed medications are those that are primarily excreted from the body through the kidneys. dosage and frequency must be adjusted based on a patient's kidney function.

5th generation Ceftaroline

Drug induced seizure

Carbapenems

Carbapenems - Doesn’t degrade in kidneys

Meropenem

Kidneys eliminate drug Reduce dose for renal dysfunction

Vancomycin

- Requires peak and trough to monitor therapeutic drug levels

Aminoglycosides: Gentamycin Amikacin Tobramycin

Aminoglycosides: Gentamycin Amikacin Tobramycin - Severe - Nephrotoxicity (reversible) - Ototoxicity (permanent) ___________ additional s/e - Severe respiratory distress - CNS – confusion, depression, disorientation, numbness and tingling - Cochlear damage

Gentamycin

- Deadly pseudomembranous colitis - Monitor for use with neuromuscular blockade meds - Monitor levels (very toxic)

Lincosamides: Clindamycin

Has beneficial effect on gastroparesis

Erythromycin

- PO – oral absorption is not great - IV – painful - Topical - Ophthalmic

Erythromycin

Do not take on empty stomach – severe GI upset!! Lots of drug/drug interactions

Erythromycin

- Tissue penetration - Long duration of action Erythromycin or azith

Azithromycin

Do not take with food – decreases absorption

Azithromycin

s/e - Tooth enamel hypoplasia and discoloration of teeth in fetus and children - Photosensitivity Contraindications - Pregnant or nursing - Kids < 8

Tetracyclines - class

- Teeth damage - (kids < 8) - n/v/d - headache - photosensitivity - dizzy - anaphylaxis - angioedema Drug will concentrate in/on - Bone - Liver - Tumor - Spleen - Teeth!! (causes damage to kids < 8)

Tetracycline

- works on meningitis - Decreases s/s of rheumatoid arthritis

Minocycline

arthropathy – joint disease avoid in young and old patients (< 18 and > 60) Prolonged post-antibiotic effects

Ciprofloxacin

- CNS disorders w/ predisposition to seizures - Kidney failure - Prolongation of QT interval - Photosensitivity - PO – 100% bioavailability

Levofloxacin

UTI - Photosensitivity

Sulfamethoxale + trimethoprim (combo drug called Bactrim)

Do not take with alcohol

Metronidazole