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exam 1a drugs COPY Flashcards

1
Q

antibiotics or antivirals?

MOA: inhibit cell wall synthesis or DNA/RNA disruption?

penicillin
cephalosporins
carbapenems
vancomycin

A

Antibiotics/antimicrobials
MOA: Inhibit cell wall synthesis

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2
Q

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

PCN
cephalosporins
carbapenems
vancomycin

A

PCN
cephalosporins
carbapenems

vancomycin = glycopeptide antibiotic

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3
Q

s/e for PCN or cephalosporins?

  • Urticaria - hives
  • Pruritis
  • Angioedema – swelling
A

PCN

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4
Q

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?

A

natural

G and V

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5
Q

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?

A

nafcillin (penicillinase resistant)

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6
Q

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

amoxicillin or ampicillin?

A

amoxicillin (PCN: aminopenicillin)

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7
Q

which has less side effects amoxicillin or ampicillin?

A

amoxicillin

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8
Q

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?

A

ampicillin (PCN: aminopenicillin)

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9
Q

the 2 PCN: aminopenicillin drugs are

A

amoxicillin and ampicillin

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10
Q

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?

A

PCN: extended spectrum
piperacillin

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11
Q

which beta lactam abx is

  • Low toxicity
  • poor oral absorption
    side effects:
  • Diarrhea
  • Abdominal cramps
  • Rash
  • Pruritis
  • Redness
  • Edema

PCN or cephalosporins?

A

cephalosporins

PCN side effects = just skin

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12
Q

which generations:

cefazolin
cephalexin

cefuroxime
cefotetan

Ceftriaxone
Ceftazidime
Cefotaxime

Cefepime

Ceftaroline

A

1st
cefazolin
cephalexin

2nd
cefuroxime
cefotetan

3rd
Ceftriaxone
Ceftazidime
Cefotaxime

4th
Cefepime

5th
Ceftaroline

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13
Q

which cephalosporins generation

  • gram +
  • staph infection s
  • non-enterococcal strep infection s

common for surgical prophylaxis

PO or IV

A

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

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14
Q

which cephalosporins generation

  • gram +
  • gram –

_________ doesn’t work on anerobic bacteria

route = PO or IV

A

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

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15
Q

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

A

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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16
Q

which cephalosporins generation

  • Gram –
  • Gram +
  • Broad spectrum
  • UTI, skin infection, pneumonias
  • Cross BBB
A

4th generation
Cefepime

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17
Q

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

A

5th generation
Ceftaroline

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18
Q

which beta lactam abx are these drugs?

Imipenem/cilastin (combo drug)
Meropenem

A

Carbapenems

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19
Q

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
A

Carbapenems
- Imipenem/cilastin (combo drug)
- Meropenem

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20
Q

which carbapenem is Very resistant to beta-lactamase?

  • Imipenem/cilastin (combo drug)
  • Meropenem
A
  • Imipenem/cilastin (combo drug) (normally carbapenems aren’t but this is a combo drug)
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21
Q

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?

A
  • Imipenem/cilastin (combo drug)
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22
Q

which carbapenem is this

  • Less coverage compared to imipenem/cilastin
  • Gram +
  • Gram –
  • Aerobes
  • Anaerobes

side effects
- Rash
- Diarrhea
- Less seizure activity

Doesn’t degrade in kidneys

Imipenem/cilastin or Meropenem?

A

Meropenem

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23
Q

which carbapenem has more coverage
Imipenem/cilastin or Meropenem?

A

Imipenem/cilastin

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24
Q

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

A

vancomycin

25
Q

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

A

vancomycin

26
Q

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

A

vancomycin (red man syndrome)

27
Q

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

A

Antimicrobials/antibiotics
MOA: DNA/RNA disruption

28
Q

Gentamycin
Amikacin
Tobramycin

are these Aminoglycosides or Lincosamides?

A

Aminoglycosides

29
Q

which abx is this? Amnioglycosides or gentamycin?

  • 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
A

Aminoglycosides:
Gentamycin
Amikacin
Tobramycin

30
Q

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?

A

gentamycin

31
Q

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.

A

Lincosamides:
Clindamycin

32
Q

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

A

Macrolides: Erythromycin, Azithromycin

33
Q

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

Do not take with food – decreases absorption

Macrolides: Erythromycin vs Azithromycin

A

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

A - Do not take with food – decreases absorption

34
Q

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,

A

Erythromycin

35
Q

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

A

Erythromycin
Antimicrobial MOA: DNA/RNA disruption

36
Q

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

A

Azithromycin
Antimicrobial MOA: DNA/RNA disruption

37
Q

Macrolides: Erythromycin vs Azithromycin

which has some advantages in coverage?

which has less GI upset?

A

both Azithromycin

38
Q

which class of abx do these belong to

Doxycycline
Minocycline

Tetracyclines or Fluoroquinolones ?

A

Tetracyclines:
Tetracycline
Doxycycline
Minocycline

39
Q

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

A

Tetracyclines: Tetracycline, Doxycycline, Minocycline

40
Q

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

A

Tetracyclines: Tetracycline, Doxycycline, Minocycline

tetracyclines = TEETH

41
Q

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)

A

Tetracycline (class and drug name)

42
Q

which tetracyclines is this -Tetracycline, Doxycycline, Minocycline

work on
- chlamydial infection
- mycoplasma infection
- prophylaxis for STI
- acne
- skin infections

A

Doxycycline

43
Q

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
A

Minocycline

44
Q

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 +

A

Fluoroquinolones: Ciprofloxacin, Levofloxacin

45
Q

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.

A

Ciprofloxacin

46
Q

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

A

Ciprofloxacin

47
Q

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

A

Levofloxacin

48
Q

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

A

Sulfonamides: Sulfamethoxale + trimethoprim (combo drug called Bactrim)

49
Q

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

A

Nitroimidazoles: Metronidazole

50
Q

antibiotics or antivirals?

Acyclovir
Oseltamivir
ganciclovir

A

antivirals (non-HIV)

51
Q

antivirals for

herpes =

flu =

cytomegalovirus (CMV) =

Acyclovir
ganciclovir
Oseltamivir

A

herpes = acyclovir

flu = oseltamivir

cytomegalovirus (CMV) = ganciclovir

52
Q

treat with abx or antiviral?

which one?

works on
- HSV 1 – oral
- HSV 2 – genital
- VZV – shingles and chicken pox
- Initial infection
- Recurrent infection

A

antiviral

herpes = acyclovir

53
Q

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

A

herpes = acyclovir

54
Q

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
A

antiviral

oseltamivir = flu

55
Q

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

A

Oseltamivir

56
Q

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.

A

antiviral

ganciclovir

57
Q

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

A

ganciclovir

58
Q

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

Acyclovir, ganciclovir, Oseltamivir

A

ganciclovir

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